MR. BLAKE BAKER III NICHOLSON (LCSW) – Clinical Social Worker, NPI 1891769261

MR. BLAKE BAKER III NICHOLSON (LCSW) is a healthcare provider. based in Greeley, Colorado. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LCSW. They hold a License No. 992906 (CO). The NPI Number for MR. BLAKE BAKER III NICHOLSON (LCSW) is 1891769261

Main info

Male
28 Years Of Experience
Accepts Medicare Assignment
Name
MR. BLAKE BAKER III NICHOLSON (LCSW)
NPI
1891769261
Phone
(970) 336-4910
Address
928 12TH ST
Enumeration Date
14 February 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Secondary Phone
9705862343
Graduation Year
1998 (28 years ago)
PAC ID
6507881695
Group Practice PAC ID
9638208549
Professional Enrollment ID
I20051007000478
Address ID
CO805176356ES131XXAVEX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

1,884 CLINICAL SOCIAL WORKER in CO

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Provider Addresses for MR. BLAKE BAKER III NICHOLSON (LCSW)

  • 928, 12th Street, Greeley, Weld County, Colorado, 80631, United States

    GREELEY, CO 806314024

    Phone: (970) 336-4910

    Fax: (970) 336-5000

    Type: Location

  • 590 FAR VIEW LN

    ESTES PARK, CO 805179049

    Phone: (970) 577-0606

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2005-10-07

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20051007000478IClinical Social WorkerCOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 80631)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9638208549View full group profile
NameSpecialtyState
Pulmonary DiseaseCO
-CO
-CO
-MO
Physician AssistantCO
-CO
Hospitalist, Internal MedicineNY
Physician AssistantCO
Physician AssistantCO
Nurse PractitionerCO

Reviews

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Frequently asked questions

How is MR. BLAKE BAKER III NICHOLSON (LCSW) identified in CMS data?
CMS-hosted NPPES data lists MR. BLAKE BAKER III NICHOLSON (LCSW) with NPI 1891769261.
Can I rely on MR. BLAKE BAKER III NICHOLSON (LCSW) being an active provider?
As of the registry snapshot, MR. BLAKE BAKER III NICHOLSON (LCSW) is marked active.
What is MR. BLAKE BAKER III NICHOLSON (LCSW)'s specialty?
The listing groups MR. BLAKE BAKER III NICHOLSON (LCSW) with Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What area does MR. BLAKE BAKER III NICHOLSON (LCSW) serve?
MR. BLAKE BAKER III NICHOLSON (LCSW)'s listing highlights Greeley, Colorado; more addresses can appear in NPPES.
Why does MR. BLAKE BAKER III NICHOLSON (LCSW) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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