Jacob I. Blazzard, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.PA.60099484 Issued in WA

Practice address

1433 5TH St
Clarkston, WA 99403-2714

Phone

(509) 758-5141

Fax

(509) 758-5299

NPI assigned

Nov 1, 2006

Last updated

Aug 4, 2026By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Dermatology of Clarkston PLLCGroup PAC ID 5597102335, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.65 of 100Reported as group

Quality

79.3

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jblazzard@directaddress.net

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.

• Integrated Dermatology of Clarkston PLLC

  • Dermatology Physician
  • Clarkston, WA
  • NPI 1609656222
  Medicare reassignment Care Compare group
• Walter Leroy Williams, M.D.

  • Dermatology Physician
  • Clarkston, WA
  • NPI 1841269248
  Medicare reassignment

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1326125485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-948-0291",
            "fax_number": "561-859-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 5TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032714",
            "telephone_number": "509-758-5141",
            "fax_number": "509-758-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZZARD",
        "first_name": "JACOB",
        "middle_name": "I.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1221",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.60099484",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60099484",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WY",
            "license": "361",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara A Bieker, BS SW
• Amelia Bieniek
• Nicole Marie Bishop
• Bonnie R Black, SOCIAL WORKER
• Elizabeth Lefft Black, MD
• Blue Mountain Family Health PLLC (Blue Mountain Family Health)
• Jace Blume
• Trudy Bly, RN,CDE
• Maggie Rosalie Bolon, LCSW
• Chad Ryan Bouterse, D.O.

• Physician Assistant in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; 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.