Dr Wyatt Kenny Blake, MD in Gray, GA - Medicare Family Medicine

Dr Wyatt Kenny Blake, MD is a medicare enrolled "Family Medicine" physician in Gray, Georgia. His current practice location is 1005 Boulder Dr, Gray, Georgia. You can reach out to his office (for appointments etc.) via phone at (478) 621-2100.

Dr Wyatt Kenny Blake is licensed to practice in Georgia (license number 047702) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1548263064.

Contact Information

	Dr Wyatt Kenny Blake, MD
	1005 Boulder Dr, Gray, GA 31032
	(478) 621-2100
	(478) 744-0481

Map and Direction

Physician's Profile

Full Name	Dr Wyatt Kenny Blake
Gender	Male
Speciality	Family Medicine
Location	1005 Boulder Dr, Gray, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1548263064
Provider Enumeration Date: 05/30/2005
Last Update Date: 07/17/2019

Medicare PECOS Information:

PECOS PAC ID: 3274423348
Enrollment ID: I20040319001351

Medical Identifiers

Medical identifiers for Dr Wyatt Kenny Blake such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1548263064	NPI	-	NPPES
000909114E	Medicaid	GA
843785	Other	GA	BCBS OF GEORGIA
080176614	Other	GA	RAILROAD MEDICARE
047702	Other	GA	GA LICENSE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	047702 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Wyatt Kenny Blake allows following entities to bill medicare on his behalf.

Entity Name	Community Primary Care Of Georgia Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1336492511 PECOS PAC ID: 0648421065 Enrollment ID: O20121113000274

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Wyatt Kenny Blake is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Wyatt Kenny Blake, MD 1005 Boulder Dr, Gray, GA 31032-6141 Ph: (478) 621-2100	Dr Wyatt Kenny Blake, MD 1005 Boulder Dr, Gray, GA 31032 Ph: (478) 621-2100

Reviews and Comments

Family Medicine Doctors in Gray, GA

Mrs. Linda S Arnold, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 260 W Clinton St, Gray, GA 31032 Phone: 478-986-4743 Fax: 478-986-3921
Dr. Melissa D Primrose, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1005 Boulder Dr, Gray, GA 31032 Phone: 478-621-2100 Fax: 770-502-2049
Meredi A Anders, PAC Family Medicine Medicare: Medicare Enrolled Practice Location: 4292 Gray Hwy, Gray, GA 31032 Phone: 478-864-3448 Fax: 478-864-1288
Dr. Robert David Campbell, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 1005 Boulder Dr, Gray, GA 31032 Phone: 478-621-2100 Fax: 478-744-0481
Jaiye A Andrews, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 4292 Gray Hwy, Gray, GA 31032 Phone: 478-864-3448 Fax: 478-864-1288
Dr. Ralph Parks Warnock, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 1005 Boulder Dr, Gray, GA 31032 Phone: 478-621-2100 Fax: 478-744-0481

Dr Wyatt Kenny Blake, MD - Medicare Family Medicine in Gray, GA