Shannon Blake, PA
NPI 1578509238ActiveIndividual· Physician Assistant· West Hartford, CT
Physician Assistant (PA) with Lifesource of North Carolina and 1 other group, practicing in West Hartford, Connecticut. 549 Medicare patients in 2024, $194,282 paid; all of their 805 Part D prescriptions were generic.
Overview
| NPI | 1578509238 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA |
| Sole proprietor | No |
| NPI issued | Jun 21, 2006 |
| Last updated in NPPES | Jul 28, 2011 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 001550 | CT |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (NC) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 549 |
|---|---|
| Services billed | 2,514 across 13 procedure codes |
| Paid by Medicare | $194,282 |
Part D prescriptions in 2024
| Prescriptions (claims) | 805 · 814 30-day fills |
|---|---|
| Patients | 118 |
| Total drug cost | $20,082 |
| Generic share | 100% of claims |
Education and affiliations
| Graduation year | 2006 |
|---|---|
| Medicare specialty | Physician Assistant |
| Telehealth | Offers telehealth |
Medical groups
- Lifesource of North CarolinaClinton, SC · 178 clinicians
- Lifesource Prime IncClinton, SC · 53 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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