CMS-1500 Box 24J / 33a • NPI
1760029862
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363A00000X (CMS 97)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant
Box 32 Service Location & ZIP+4
151 WORCESTER RD, BARRE, MA, 01005-9002
✓ 9-Digit EDI 837 ZIP+4 (01005-9002)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1760029862 (PETER JONATHAN BLAKE, PA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1760029862)
Medicare Beneficiaries
187
Total Billed Services
473
Distinct CPT/HCPCS Codes
16
Medicare Allowed Total
$24,823.71
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 147 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 93 |
99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 32 |
99442 | Telephone medical discussion with physician, 11-20 minutes | 19 |
99495 | Transitional care management services for problem of at least moderate complexity | 17 |
G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 34 |
G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's | 117 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Albuterol Sulfate Hfa Albuterol Sulfate | 51 | 27 |
| Allopurinol Allopurinol | 25 | <11 |
| Alprazolam Alprazolam | 11 | <11 |
| Amlodipine Besylate Amlodipine Besylate | 105 | 39 |
| Amoxicillin-Clavulanate Potass Amoxicillin/Potassium Clav | 16 | 16 |
| Aripiprazole Aripiprazole | 16 | <11 |
| Atenolol Atenolol | 21 | <11 |
| Atorvastatin Calcium Atorvastatin Calcium | 202 | 75 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1760029862 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | PETER JONATHAN BLAKE, PA |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant NUCC Code: 363A00000X (Physician Assistant) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 151 WORCESTER RD, BARRE, MA, 01005-9002 |
| Practice Telephone / Fax | Tel: (783) 556-3219 | Fax: (978) 355-6549 |
| Administrative Mailing Address | PO BOX 415348, BOSTON, MA, 02241-5348 |
| Enumeration & Last Sync | Enumerated: 2019-12-08 | CMS Record Updated: 2023-05-02 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363A00000X)
What Does Taxonomy Code 363A00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (PETER JONATHAN BLAKE, PA)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363AM0700X — Physician Assistant, MedicalPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical | State: MA | License: PA8403 | Primary: Secondary |
363A00000X — Physician AssistantPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant | State: MA | License: PA8403 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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