Jerry Gene Blaivas, M.D.

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

144945 1 Issued in NY

Practice address

445 E 77TH St
New York, NY 10021-2318

Phone

(212) 772-3900

Fax

(212) 772-1919

NPI assigned

Jun 12, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2013 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• New York City Urology, PLLC

  • Urology Physician
  • New York, NY
  • NPI 1912219452
  NPD (past) Authorized official
• LHHN Medical, P.C.

  • Family Medicine Physician
  • New York, NY
  • NPI 1740222181
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124060330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212318",
            "telephone_number": "212-772-3900",
            "fax_number": "212-772-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212318",
            "telephone_number": "212-772-3900",
            "fax_number": "212-772-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIVAS",
        "first_name": "JERRY",
        "middle_name": "GENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "144945 1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leo J Blais
• Adam Blaisdell
• Christopher Blaisdell, CRNP-BC
• Amy Blaise
• Allen Jay Blaivas, DO
• Kwanisha T. Blaize, FNP-BC
• Tracey Monique Blake-Dixon, PA-C
• Alistair Blake, LCSW
• Benjamin Blake
• Chanel Blake, COTA

• All providers in New York, NY
• Legal Medicine in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.