Danice Blaise, MD,MBA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ACN1418 Issued in FL

Practice address

684 State Road 60 W
Lake Wales, FL 33853-4419

Phone

(863) 949-4868

Fax

(863) 223-8549

NPI assigned

Apr 27, 2018

Last updated

Dec 7, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

General Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Center for Functional Aesthetic and Anti Aging Medicine Inc

  • Internal Medicine Physician
  • Winter Haven, FL
  • NPI 1508682089
  Medicare reassignment Authorized official
• Medical Home Alliance LLC

  dba IMA Medical Group - Lake Wales

  • Internal Medicine Physician
  • Lake Wales, FL
  • NPI 1417622853
  NPD
• Medical Home Alliance LLC

  dba IMA Winter Haven Dispensary

  • Non-Pharmacy Dispensing Site
  • Winter Haven, FL
  • NPI 1033648233
  NPD (past)

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733529600000",
    "number": "1255829966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 STATE ROAD 60 W",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534419",
            "telephone_number": "863-949-4868",
            "fax_number": "863-223-8549"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "571 Avenue K SE",
            "address_purpose": "LOCATION",
            "city": "Winter Haven",
            "state": "FL",
            "postal_code": "338804215",
            "country_code": "US",
            "telephone_number": "407-440-0708",
            "fax_number": "407-357-0347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAISE",
        "first_name": "DANICE",
        "name_prefix": "Dr.",
        "credential": "MD,MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-27",
        "last_updated": "2024-12-07",
        "certification_date": "2024-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2019045102",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "CV2000213",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "25173",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115752400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Ann Benton
• Jeffrey Berdahl
• Julia Hunt Berkau, PT
• Best Value Healthcare (Ridge Medical Associates)
• Misty Bittner
• Thomas Martin Bonds I
• Brain Spine and Sleep Institute LLC (Brain Spine and Sleep Institute)
• Colette Braunstein, LCSW
• Roy Z Braunstein, MD
• Breuer Health of Lake Wales LLC

• General Practice Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2024; 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.