NPIMap

Individual provider Active NPI

Courtney Breanne Blasczyk, PA-C

  • Physician Assistant
  • Springfield, MO
National Provider Identifier
1104688084
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2024003138 Issued in MO
Practice address
2115 S Fremont Ave Ste 2300
Springfield, MO 65804-2233
Phone
(417) 820-5600
NPI assigned
Jan 26, 2024
Last updated
Jan 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2024003138 MO Primary

Addresses

Primary practice location

2115 S Fremont Ave Ste 2300
Springfield, MO 65804-2233

Mailing address

2115 S Fremont Ave Ste 2300
Springfield, MO 65804-2233
Phone (417) 616-4479

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20240220001258 MO Practitioner - Physician Assistant 4688018518 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

2115 S Fremont Ave
1100 MC Womens Oncology Whiteside
Springfield, MO 65804-2239
Phone (417) 820-3554

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

2115 S Fremont Ave
3100 MC Lab and Imaging Services Whiteside
Springfield, MO 65804-2205
Phone (417) 820-3738

2135 S Fremont Ave
MC Physical Med and Rehab
Springfield, MO 65804-2239
Phone (417) 820-2364

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Feb 19, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 19, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 19, 2024 Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 2300
Springfield, MO 65804
Phone (417) 820-2675

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768348800000",
    "number": "1104688084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE STE 2300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042233",
            "telephone_number": "417-616-4479",
            "fax_number": "417-820-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE STE 2300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042233",
            "telephone_number": "417-820-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLASCZYK",
        "first_name": "COURTNEY",
        "middle_name": "BREANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-26",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024003138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.