Trystan Blake, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

13772735-1204 Issued in UT

Practice address

707 E Main St
Middletown, NY 10940-2650

Phone

(845) 333-7373

NPI assigned

Apr 16, 2021

Last updated

Nov 26, 2024By 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 UT

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

Family Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital - Salt Lake Hospital, Salt Lake City, UT, CCN 460003

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

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.

• Catholic Health Initiatives Colorado

  dba Behavioral Health West Valley

  • Prescribing (Medical) Psychologist
  • West Valley City, UT
  • NPI 1942903562
  Medicare reassignment Care Compare group NPD
• Catholic Health Initiatives Colorado

  dba Neuroscience & Rehabilitation Lehi Mountain Point

  • Neurology Physician
  • Lehi, UT
  • NPI 1205538162
  NPD
• Catholic Health Initiatives Colorado

  dba CommonSpirit Orthopedics Longmont

  • Orthopaedic Surgery Physician
  • Longmont, CO
  • NPI 1891675294
  NPD
• Catholic Health Initiatives Colorado

  dba NSSH Neurosurg Sah

  • Neurological Surgery Physician
  • Lakewood, CO
  • NPI 1205846664
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Catholic Health Initiatives Colorado

  dba Holy Cross Hospital - Salt Lake

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1043915523
  Care Compare affiliation

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1275114753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "82 S 1100 E Ste 403",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841021892",
            "country_code": "US",
            "telephone_number": "801-505-5299",
            "fax_number": "801-350-4753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "TRYSTAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-16",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "13772735-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Lynette Black, M.D.
• Julie J Black, FNP
• Elisha Blain
• Joshua James Blair, PA-C
• Nicole Blair, MD
• Daniel Benjamin Blau, DDS
• David L Bloch, PH.D.
• Ricki Block, MS, CCC-SLP
• Susan Block, O.D.
• Zachary Thomas Blome, PA-C

• Family Medicine Physician in Middletown, NY
• Providers in Middletown, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.