Blaze Kelly, DO

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

81122 Issued in CT

Practice address

267 Grant St
Bridgeport, CT 06610-2805

Phone

(203) 384-3000

Fax

(203) 384-4108

NPI assigned

Apr 3, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, CT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Pain ManagementAlso: Anesthesiology

Education

Lake Erie College of Osteopathic Medicine, Erie, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010

Merit-based Incentive Payment System (MIPS)

Final score

84.91 of 100Reported as group

Quality

73.58

Promoting interoperability

100

Improvement activities

40

Cost

76.13

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Yale University

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236
  Medicare reassignment Care Compare group NPD
• University of Penn-Medical Group

  • Gynecologic Oncology Physician
  • Philadelphia, PA
  • NPI 1235527342
  Medicare reassignment NPD
• Yale University

  • Adult Mental Health Clinic/Center
  • Hamden, CT
  • NPI 1134391824
  NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• University of Penn-Medical Group

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1548658560
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1649260845
  Care Compare affiliation
• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1992910152
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1003445842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST STE 8290",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-2370",
            "fax_number": "215-955-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3000",
            "fax_number": "203-384-4108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 S 11th St Ste 8290",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074824",
            "country_code": "US",
            "telephone_number": "215-955-2370 x21595",
            "fax_number": "215-955-0677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "BLAZE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-03",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT019937",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CT",
            "license": "81122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Keenan, PMHNP
• Lisa Maria Kegel, N.P.
• Andrew John Kehrer, DO
• Jill S Keller, APRN
• Barbara Kelly, LPC
• Lauren Alexis Kelly, PA-C
• Sarena Kelly, MSN, FNP-BC
• Sean R. Kelly, MD
• Natalia Kembaren, BCBA
• Andrew S Kenler, M.D.

• Pain Medicine (Anesthesiology) Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Pain Medicine (Anesthesiology) Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.