NPIMap

Individual provider Active NPI

Keith P Blaquiere, PA

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1265735369
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA4100 Issued in MA
Practice address
55 Fruit St
Boston, MA 02114-2621
Phone
(508) 566-2429
NPI assigned
Dec 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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 PA4100 MA Primary

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2621

Mailing address

49 Grand Oak Rd
Forestdale, MA 02644-1202
Phone (508) 566-2429

Other practice location 1

100 Ter Heun Dr
Falmouth, MA 02540-2599
Phone (508) 548-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20110517000324 MA Practitioner - Physician Assistant 4082890611 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians of Falmouth HospitalGroup PAC ID 6800051970, 92 clinicians
Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

100 Ter Heun Dr
Falmouth, MA 02540-2503
Phone (508) 771-1800

184 Ter Heun Dr
Falmouth, MA 02540-2503
Phone (508) 457-4621

311 Service Rd
East Sandwich, MA 02537-1370
Phone (508) 833-4000

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

  • Cape Cod Hospital Hospital, Hyannis, MA, CCN 220012
  • Falmouth Hospital Hospital, Falmouth, MA, CCN 220135
  • Beth Israel Deaconess Hospital Plymouth Hospital, Plymouth, MA, CCN 220060
  • Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spaulding Rehabilitation Hospital Corporation Current Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Jan 21, 2024 Accepting new patients
Medical Affiliates of Cape Cod, Inc. CurrentSince Aug 30, 2015 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

311 Service Rd
East Sandwich, MA 02537
Phone (508) 833-4000

100 Ter Heun Dr
Falmouth, MA 02540
Phone (508) 457-3501

27 Park St
Hyannis, MA 02601
Phone (508) 775-5011

Interoperability endpoints

  • Direct secure messaging: blaquiere.keith.shc@direct.partners.masshiway.net

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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": "1291939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1265735369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 GRAND OAK RD",
            "city": "FORESTDALE",
            "state": "MA",
            "postal_code": "026441202",
            "telephone_number": "508-566-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "508-566-2429"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Ter Heun Dr",
            "address_purpose": "LOCATION",
            "city": "Falmouth",
            "state": "MA",
            "postal_code": "025402599",
            "country_code": "US",
            "telephone_number": "508-548-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAQUIERE",
        "first_name": "KEITH",
        "middle_name": "P",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-10",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.