Individual provider Active NPI

Marisa Blitstein, M.D.

  • Diagnostic Radiology Physician
  • Springfield, IL
National Provider Identifier
1194914465
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036135461 Issued in IL
Practice address
701 N 1St St
Springfield, IL 62781-0001
Phone
(217) 726-3389
NPI assigned
Oct 23, 2007
Last updated
Nov 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036135461 IL Primary
Diagnostic Radiology Physician 2085R0202X 2014022413 MO

Addresses

Primary practice location

701 N 1St St
Springfield, IL 62781-0001

Mailing address

3050 Montvale Dr
Springfield, IL 62704-4290
Phone (217) 726-3389

Other practice location 1

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-0690

Other practice location 2

7900 Lees Summit Rd
Kansas City, MO 64139-1236
Phone (816) 404-0690

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140813000079 IL Practitioner - Diagnostic Radiology 1557527751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Warren Alpert Medical School of Brown University, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

1000 W Morton Ave
Jacksonville, IL 62650-3152
Phone (217) 243-6520

1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541

1600 W Walnut St
Jacksonville, IL 62650-1136
Phone (217) 245-9541

200 Stahlhut Dr 1St Floor Room
Suite 428
Lincoln, IL 62656-5066
Phone (217) 605-5309

201 E Pleasant St
Taylorville, IL 62568-1562
Phone (217) 824-3566

2200 Wabash Ave
Springfield, IL 62704-5352
Phone (217) 787-0727

350 W Carpenter St
Springfield, IL 62702-4902
Phone (217) 525-0210

400 Saint Johns Dr
Sherman, IL 62684-9779
Phone (217) 525-4150

4525 Wabash Ave
Springfield, IL 62711-7038
Phone (217) 528-7541

600 N Main St
Taylorville, IL 62568-1668
Phone (217) 824-8191

701 N 1St St
Springfield, IL 62781-0001
Phone (217) 528-7541

775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300

800 N 1St St
Springfield, IL 62702-3719
Phone (217) 528-7541

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as apm
Quality
75.65
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036135461ILMDDiagnostic Radiology Physician
2014022413MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Clinic, LLP CurrentSince Aug 1, 2014 Accepting new patients
Crawford Hospital District Current Accepting new patients
Memorial Medical Center Past Accepting new patients
Clinical Radiologists, S.C. Diagnostic Radiology Past Accepting new patients
Clinical Radiologists, S.C. Diagnostic Radiology Past Accepting new patients

Locations

1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131

1025 S 6th St
Springfield, IL 62703

701 N 1st St
Springfield, IL 62781
Phone (217) 788-3100

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

Interoperability endpoints

  • Direct secure messaging: marisa.blitstein.1@28977.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Springfield Clinic Lincoln Rural HealthLincoln, IL, CCN 143925 Rural health clinic Limited Partnership Interest Jul 1, 2021
Springfield Clinic Nokomis Rural HealthNokomis, IL, CCN 783814 Rural health clinic Limited Partnership Interest Jul 1, 2021
Springfield Clinic Raymond Rural HealthRaymond, IL, CCN 783829 Rural health clinic Limited Partnership Interest Jul 1, 2021
Springfield Clinic Neoga Rural HealthNeoga, IL, CCN 783812 Rural health clinic Limited Partnership Interest Jul 1, 2021
Springfield Clinic, LLPMacomb, IL, CCN 783855 Rural health clinic Limited Partnership Interest Jul 1, 2021

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 5

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": "1193097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1194914465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 MONTVALE DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044290",
            "telephone_number": "217-726-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627810001",
            "telephone_number": "217-726-3389"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Holmes St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082640",
            "country_code": "US",
            "telephone_number": "816-404-0690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7900 Lees Summit Rd",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641391236",
            "country_code": "US",
            "telephone_number": "816-404-0690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLITSTEIN",
        "first_name": "MARISA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-23",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036135461",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2014022413",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.