Keely Marie Blosh, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704310535 Issued in MI

Practice address

416 Connable Ave
Petoskey, MI 49770-2212

Phone

(231) 487-4000

Fax

(231) 547-3424

NPI assigned

Jul 6, 2017

Sex

Female

Sole proprietor

No

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.

• Center for Pulmonary and Sleep Medicine PC

  • Pulmonary Disease Physician
  • Petoskey, MI
  • NPI 1962618215
  Medicare reassignment NPD MI

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 18, 2021.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1013438530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4000",
            "fax_number": "231-547-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4000",
            "fax_number": "231-547-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOSH",
        "first_name": "KEELY",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-06",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704310535",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704310535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Bielaczyc, MD
• Mark James Bielaczyc, M.D.
• Sue Bissell I, LMSW
• Thomas Richard Biziorek, D.D.S., M.SC.D.
• Paul D Blanchard, M.D.
• Amy Bodnarchuk, M.D.
• Laura Davis Bogner, RPH
• Timothy Ivan Bondy, PT
• Laurie Anne Bonnington, RPH
• Katie Elizabeth Boonie, PHARMACY TECHNICIAN

• All providers in Petoskey, MI
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.