Douglas Alan Blazer, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085004130 Issued in IL

Practice address

3475 S Alpine Rd
Rockford, IL 61109-2604

Phone

(815) 874-8000

NPI assigned

Oct 13, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Physicians Immediate Care North Chicago LLC

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1205814118

  IL

  Medicare reassignment Care Compare group
• Wellnow Urgent Care, PC

  • Urgent Care Clinic/Center
  • Liverpool, NY
  • NPI 1669825162

  IL

  Medicare reassignment
• Fastrac Medical, P.C.

  • Emergency Medicine Physician
  • Joliet, IL
  • NPI 1659517597
  NPD (past)

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1104101823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 S ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092604",
            "telephone_number": "815-874-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 S ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092604",
            "telephone_number": "815-874-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZER",
        "first_name": "DOUGLAS",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-13",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085004130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "085004130",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Blanck, PT, DPT
• Deanne Blanco, OTR/L
• Rachel A Bland, CNM
• Carrie M. Blaser, APNP
• Jennifer Ann Blaser, PTA
• Andrew Jay Blint, M.D.
• Kevin T Block Jr., PHARMD
• Bloom Therapeutics, LLC
• Bluebird Counseling and Psychotherapy
• Bluestem Counseling, PLLC

• All providers in Rockford, IL
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; 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.