Active NPI 1508826587 Individual Practitioner Male Practitioner

Dr. John S Blake , MD

Dermatology - MOHS-Micrographic Surgery • Roosevelt, UT

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. John Blake, MD is a certified Dermatology - MOHS-Micrographic Surgery practicing in Roosevelt, UT. With approximately 38 years of clinical experience since graduating from University Of Utah School Of Medicine in 1988, Dr. Blake delivers high-quality medical care to the local community at 210 W 300 N 7-3.

Dr. Blake is affiliated with Northeastern Utah Medical Group and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

210 W 300 N 7-3

Roosevelt, UT 84066

Telephone 4357223971

Fax 4357226104

Associated Practice Facility / Clinic

🏢 Northeastern Utah Medical Group Facility NPI 1982664199

Medicare Profile & Education

Medical School

University Of Utah School Of Medicine

Graduation Year

1988

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology - MOHS-Micrographic Surgery in Roosevelt, UT

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

38 Yrs Matches City Avg

City Avg: 38.0 Yrs

State Avg: 17.0 Yrs

Regional Practice Density

1 Specialists

Practicing in Roosevelt, UT (18 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

63.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Blake (38 Years) 38 Yrs

Roosevelt Specialty Average (38.0 Years) 38.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,064	159	$24.46	$6.39
99213 Established patient office or other outpatient visit, typically 15 minutes	413	266	$130.00	$88.76
17000 Destruction of skin growth	282	193	$170.20	$51.92
88305 Pathology examination of tissue using a microscope, intermediate complexity	223	150	$117.09	$36.04
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	215	173	$1531.30	$576.17
11102 Tangential biopsy of single skin lesion	174	139	$210.59	$94.27
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	65	62	$681.92	$152.67
11103 Biopsy of related skin growth, each additional growth	65	41	$114.88	$48.34
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	40	32	$921.42	$398.49
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	33	30	$858.64	$154.95
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	25	24	$712.56	$234.39
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	25	23	$403.80	$163.18
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	23	22	$1859.74	$750.68
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	14	11	$342.29	$113.08
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	12	12	$1818.00	$741.89
17004 Destruction of precancer skin growth, 15 or more growths	11	11	$360.00	$161.35

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,335	193	$23.37	$6.39
99213 Established patient office or other outpatient visit, typically 15 minutes	530	352	$127.68	$87.19
17000 Destruction of skin growth	350	247	$165.20	$51.87
88305 Pathology examination of tissue using a microscope, intermediate complexity	269	162	$131.14	$35.72
11102 Tangential biopsy of single skin lesion	209	173	$204.53	$93.01
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	160	119	$1511.00	$581.90
11103 Biopsy of related skin growth, each additional growth	104	65	$112.18	$48.36
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	82	71	$673.00	$160.06
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	44	33	$904.80	$395.71
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	34	30	$720.53	$162.76
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	32	30	$705.00	$228.82
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	31	28	$399.00	$166.72
17004 Destruction of precancer skin growth, 15 or more growths	30	26	$346.33	$162.51
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	15	13	$333.33	$128.22
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$146.13	$69.76
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	12	12	$1769.67	$719.36
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	12	12	$1820.50	$743.29

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,089	207	$22.43	$6.48
99213 Established patient office or other outpatient visit, typically 15 minutes	634	394	$123.96	$87.81
17000 Destruction of skin growth	383	264	$160.60	$51.71
11102 Tangential biopsy of single skin lesion	270	225	$198.89	$97.24
88305 Pathology examination of tissue using a microscope, intermediate complexity	145	89	$140.86	$36.65
11103 Biopsy of related skin growth, each additional growth	134	76	$109.43	$49.05
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	119	95	$1473.29	$607.26
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	84	71	$662.29	$157.47
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	46	35	$393.52	$146.46
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	45	32	$862.16	$396.12
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	31	26	$695.52	$237.05
17004 Destruction of precancer skin growth, 15 or more growths	30	28	$339.67	$162.29
99202 New patient office or other outpatient visit, typically 20 minutes	29	29	$142.21	$70.39
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	21	20	$652.86	$172.44
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	18	18	$1722.50	$711.46
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	14	$422.43	$169.28
11104 Punch biopsy, first skin growth	11	11	$255.64	$122.67
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	11	11	$585.36	$163.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,366	210	$21.44	$6.21
99213 Established patient office or other outpatient visit, typically 15 minutes	647	446	$119.56	$88.12
17000 Destruction of skin growth	353	266	$155.21	$50.75
11102 Tangential biopsy of single skin lesion	230	198	$192.63	$97.63
88305 Pathology examination of tissue using a microscope, intermediate complexity	195	125	$139.03	$36.51
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	136	104	$1445.50	$578.44
11103 Biopsy of related skin growth, each additional growth	110	72	$106.47	$50.21
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	54	47	$641.39	$155.65
99202 New patient office or other outpatient visit, typically 20 minutes	51	51	$137.73	$70.30
17004 Destruction of precancer skin growth, 15 or more growths	35	31	$328.43	$159.03
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	34	30	$850.71	$393.97
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	30	28	$378.93	$154.71
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	24	24	$674.00	$266.00
11104 Punch biopsy, first skin growth	24	23	$247.92	$124.61
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	17	17	$1671.06	$730.84
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	16	15	$563.44	$145.66
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	13	13	$446.00	$198.92
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	11	11	$315.55	$129.61

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,518	235	$21.00	$5.71
99213 Established patient office or other outpatient visit, typically 15 minutes	691	483	$117.98	$72.59
17000 Destruction of skin growth	405	307	$153.00	$51.82
88305 Pathology examination of tissue using a microscope, intermediate complexity	246	165	$137.00	$37.83
11102 Tangential biopsy of single skin lesion	237	206	$190.00	$94.58
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	117	95	$1424.00	$575.68
11103 Biopsy of related skin growth, each additional growth	92	54	$105.00	$51.26
99202 New patient office or other outpatient visit, typically 20 minutes	58	58	$136.00	$73.87
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	53	44	$376.00	$152.56
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	51	47	$634.00	$149.70
17004 Destruction of precancer skin growth, 15 or more growths	45	38	$323.00	$149.24
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	34	33	$836.00	$379.29
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	31	28	$664.00	$264.15
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	18	18	$1648.00	$742.66
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	16	16	$309.00	$136.62
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	14	13	$556.00	$150.47
11104 Punch biopsy, first skin growth	13	13	$245.00	$114.51
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	12	11	$401.00	$165.62

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,637	258	$21.00	$5.42
99213 Established patient office or other outpatient visit, typically 15 minutes	802	552	$118.00	$71.89
17000 Destruction of skin growth	430	348	$153.00	$53.51
88305 Pathology examination of tissue using a microscope, intermediate complexity	258	168	$137.00	$37.60
11102 Tangential biopsy of single skin lesion	243	205	$190.00	$90.93
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	123	95	$1424.00	$590.56
11103 Biopsy of related skin growth, each additional growth	101	64	$105.00	$50.58
99202 New patient office or other outpatient visit, typically 20 minutes	88	88	$136.00	$73.62
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	66	59	$376.00	$156.61
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	50	43	$634.00	$154.91
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	47	32	$836.00	$383.14
17004 Destruction of precancer skin growth, 15 or more growths	46	42	$322.37	$145.86
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	28	26	$309.00	$124.82
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	23	20	$664.00	$224.12
11104 Punch biopsy, first skin growth	21	20	$245.00	$112.16
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	18	17	$1648.00	$746.92
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	16	16	$556.00	$144.73

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,241	292	$20.47	$4.95
99213 Established patient office or other outpatient visit, typically 15 minutes	858	573	$114.74	$68.61
95044 Test for allergy using skin patch	648	14	$15.22	$5.19
17000 Destruction of skin growth	494	390	$148.87	$51.66
11100 Biopsy of single growth of skin and/or tissue	290	250	$216.77	$96.59
88305 Pathology examination of tissue using a microscope, intermediate complexity	251	184	$133.91	$36.87
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	121	104	$1390.08	$558.00
99202 New patient office or other outpatient visit, typically 20 minutes	91	91	$132.08	$70.81
11101 Biopsy of each additional growth of skin and/or tissue	82	62	$68.80	$30.85
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	56	51	$366.84	$158.00
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	49	48	$621.59	$148.09
17004 Destruction of precancer skin growth, 15 or more growths	40	40	$312.20	$131.15
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	40	35	$816.05	$364.98
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	28	27	$305.00	$130.75
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	25	25	$1604.32	$723.45
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	20	20	$648.70	$241.12
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	16	15	$540.25	$121.52

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,257	342	$22.39	$5.29
99213 Established patient office or other outpatient visit, typically 15 minutes	1,098	727	$112.00	$69.24
17000 Destruction of skin growth	557	413	$149.76	$51.54
11100 Biopsy of single growth of skin and/or tissue	374	321	$211.00	$92.61
88305 Pathology examination of tissue using a microscope, intermediate complexity	350	221	$104.18	$36.92
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	144	115	$1352.00	$554.20
11101 Biopsy of each additional growth of skin and/or tissue	130	81	$68.59	$30.26
17004 Destruction of precancer skin growth, 15 or more growths	69	60	$307.00	$141.81
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	61	56	$357.00	$157.66
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	61	57	$602.00	$151.21
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	51	33	$794.00	$362.98
17110 Destruction of up to 14 skin growths	50	46	$226.00	$99.18
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	23	22	$293.00	$125.02
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	23	22	$1564.00	$712.11
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	22	22	$630.00	$247.78
10060 Simple or single drainage of skin abscess	13	13	$235.00	$112.15
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	13	13	$528.00	$140.98
99202 New patient office or other outpatient visit, typically 20 minutes	12	12	$129.00	$67.38
87220 Tissue fungi or parasites	11	11	$15.00	$5.74

Medical Specialties & State Licenses

Dermatology - MOHS-Micrographic Surgery Primary Specialty

NUCC Taxonomy Code: 207ND0101X

State License UT 49109901205

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

D3948 (UT)

Hospital & Practice Group Affiliations

Northeastern Utah Medical Group

250 W 300, Roosevelt, UT 840662336

Northeastern Utah Medical Group

475 N 500, Vernal, UT 840781907

Phone: 4357812030

Northeastern Utah Medical Group

405 N 500, Vernal, UT 840781907

Phone: 4357896203

Northeastern Utah Medical Group

210 W 300, Roosevelt, UT 840662336

Phone: 4357224691

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

16 Associated Practitioners

Dr. Shannon Staker , MD

Pediatrics

NPI 1023078045

Doctor of Medicine (M.D.)

Darwin Mckee , PA-C

Physician Assistant

NPI 1023079910

Physician Assistant (Certified)

Lori Teem , FNP

Nurse Practitioner

NPI 1083675649

Family Nurse Practitioner

Dr. John Nolte , MD

Obstetrics & Gynecology

NPI 1194786095

Doctor of Medicine (M.D.)

Dr. Gary White , MD

Family Medicine

NPI 1205897196

Doctor of Medicine (M.D.)

Dr. Gregory Staker , MD

Pediatrics

NPI 1275593717

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

✅

NPI Profile Active May 02, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location May 02, 2017

Registered at 210 W 300 N 7-3, ROOSEVELT, UT 84066 (Tel: 4357223971)

📍

Updated Business Mailing Address May 02, 2017

Registered at 210 W 300 N 7-3, ROOSEVELT, UT 84066 (Tel: 4357223971)

👤

Provider Name / Credentials Updated May 02, 2017

Recorded as JOHN BLAKE, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 02, 2017

Dermatology (License #49109901205 in UT)

✅

NPI Profile Active December 06, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location December 06, 2007

Registered at 210 W 300 N 7-3, ROOSEVELT, UT 84066 (Tel: 4357223971)

📍

Updated Business Mailing Address December 06, 2007

Registered at 210 W 300 N 7-3, ROOSEVELT, UT 84066 (Tel: 4357223971)

👤

Provider Name / Credentials Updated December 06, 2007

Recorded as JOHN BLAKE, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 06, 2007

Dermatology (License #49109901205 in UT)

🟢

Initial NPI Registration & Enumeration March 24, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1508826587

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: March 24, 2006

Last Update: May 02, 2017

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

210 W 300 N 7-3

Roosevelt, UT 84066

Phone: 4357223971

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.