NPIMap

Individual provider Active NPI

Blair Kaichen Duddy, MD

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1063414761
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
7316 Issued in NV
Practice address
2704 N Tenaya Way
Las Vegas, NV 89128-0424
Phone
(702) 243-8500
Fax
(702) 869-5347
NPI assigned
Aug 11, 2005
Last updated
Sep 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 7316 NV Primary

Addresses

Primary practice location

2704 N Tenaya Way
Las Vegas, NV 89128-0424

Mailing address

PO Box 15645
Las Vegas, NV 89114-5645
Phone (702) 579-3298

Other identifiers 2

IdentifierTypeStateIssuer
1063414761MedicaidNV
V114364OtherNVSSMA MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040817001132 NV Practitioner - Pediatric Medicine 5799758744 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7316NVMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Medical Group Coats LTD Pediatrics Current Accepting new patients
Southwest Medical Associates, Inc CurrentSince Aug 22, 2016 Accepting new patients
Optum Medical Group Rhodes P C Current Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 1, 2019 Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Bacchus PC PastSince Apr 1, 2018 Accepting new patients
Healthcare Partners Medical Group (Coats), LTD. Pediatrics Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients

Locations

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

2704 N Tenaya Way
Las Vegas, NV 89128
Phone (702) 243-8500

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

Interoperability endpoints

  • Direct secure messaging: bduddy119206@westdirect.optum.com

Organizations & group practices 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1063414761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15645",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891145645",
            "telephone_number": "702-579-3298",
            "fax_number": "702-667-4689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 N TENAYA WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280424",
            "telephone_number": "702-243-8500",
            "fax_number": "702-869-5347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDDY",
        "first_name": "BLAIR",
        "middle_name": "KAICHEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "7316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063414761",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSMA MEDICARE",
            "identifier": "V114364",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.