Kacey Dustin Blaylock, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100370 Issued in ID

Practice address

360 E Mallard Dr Ste 110
Boise, ID 83706-3945

Phone

(208) 336-8700

Fax

(208) 426-0902

NPI assigned

Jun 7, 2016

Last updated

Jun 16, 2021By the provider in NPPES

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

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hollingshead Eye Center PCGroup PAC ID 9830133214, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.27 of 100Reported as group

Quality

84.52

Promoting interoperability

98

Improvement activities

40

Cost

78.04

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kacey.blaylock@direct.revolutionehr.com
• Direct secure messaging: kblaylock@hollingsheadeyecenter.emadirect.md

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.

• Hollingshead Eye Center, PC

  • Ophthalmology Physician
  • Boise, ID
  • NPI 1871643585

  Optometrist

  Medicare reassignment Care Compare group NPD
• LWK, P.C.

  dba Eye Pros

  • Optometrist
  • Boise, ID
  • NPI 1851624019
  Medicare reassignment NPD

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1164871489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E MALLARD DR STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063945",
            "telephone_number": "208-336-8700",
            "fax_number": "208-426-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E MALLARD DR STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063945",
            "telephone_number": "208-336-8700",
            "fax_number": "208-426-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAYLOCK",
        "first_name": "KACEY",
        "middle_name": "DUSTIN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-07",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Herbert Ray Blaser, DDS
• Ryan James Blaser, D.O.
• Travis Blaser, FNP
• Donald John Blaskiewicz, M.D.
• Justin Blaty, MD
• Clarence W Blea, MD
• Kacey Blea
• Rob Blest
• Kaitlyn Blevins
• Kyle Blevins, D.C.

• Optometrist in Boise, ID
• Providers in Boise, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.
• 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.