NPIMap

Individual provider Active NPI

Theodore Blaine, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • New York, NY
National Provider Identifier
1376576421
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
039067 Issued in CT
Practice address
535 E 70TH St
New York, NY 10021-4823
Phone
(203) 705-0766
Fax
(860) 247-3803
NPI assigned
Jul 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 12523 RI
Orthopaedic Surgery Physician 207X00000X 196273-1 NY
Orthopaedic Surgery Physician 207X00000X 39067 CT
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 039067 CT Primary

Addresses

Primary practice location

535 E 70TH St
New York, NY 10021-4823

Mailing address

PO Box 29234
New York, NY 10087-9234
Phone (203) 705-0766

Other identifiers 1

IdentifierTypeStateIssuer
200001063OtherCTCT MEDICARE NUMBER

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address tblaine109313@direct.HSS.edu Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/ Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041209000952 CT Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 0143286237 Reassigns benefits to 2 organizations
I20190903003076 NY Practitioner - Orthopedic Surgery 0143286237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
University of Connecticut School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rehabilitation Associates IncGroup PAC ID 8022905322, shared by 2 NPIs, 525 clinicians

Practice addresses (Care Compare)

1 Blachley Rd
Stamford, CT 06902-0002
Phone (212) 774-7598

1931 Black Rock Tpke
Fairfield, CT 06825-3506
Phone (203) 384-8681

535 E 70TH St
New York, NY 10021-4823
Phone (646) 797-8471

Hospital & facility affiliations

  • Hospital for Special Surgery Hospital, New York, NY, CCN 330270
  • Stamford Hospital Hospital, Stamford, CT, CCN 070006
  • Danbury Hospital Hospital, Danbury, CT, CCN 070033
  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)76

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
196273-1NYMDOrthopaedic Surgery Physician
12523RIMDOrthopaedic Surgery Physician
039067CTMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ny Society for the Relief of Ruptured & Crippled Maintaining Orthopaedic Surgery CurrentSince Oct 19, 2019 Accepting new patients
Ny Society for the Relief of Ruptured & Crippled Maintaining Orthopaedic Surgery CurrentSince Oct 19, 2019 Accepting new patients
Orthopedic Associates of Hartford,PC Orthopaedic Surgery CurrentSince Nov 1, 2017 Accepting new patients
Orthopedic Associates of Hartford,PC Orthopaedic Surgery CurrentSince Nov 1, 2017 Accepting new patients
New York Orthopaedic Hospital Associates, PC Orthopaedic Surgery Past Accepting new patients
Trustees of Columbia University in the City of New York Orthopaedic Surgery Past Accepting new patients

Locations

270 Farmington Ave
Ste 102
Farmington, CT 06032

499 Farmington Ave
Ste 300
Farmington, CT 06032
Phone (860) 549-8986

2080 Whitney Ave
Ste 280
Hamden, CT 06518
Phone (203) 248-6200

31 Seymour St
Ste 100
Hartford, CT 06106
Phone (860) 549-8208

32 Strawberry Hill Ct
Stamford, CT 06902
Phone (203) 276-2000

1 Blachley Rd
Stamford, CT 06902
Phone (203) 705-0750

1 Hospital Plz
Stamford, CT 06902
Phone (203) 276-4925

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • Direct secure messaging: tblaine109313@direct.hss.edu
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 6

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1376576421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29234",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100879234",
            "telephone_number": "203-705-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823",
            "telephone_number": "203-705-0766",
            "fax_number": "860-247-3803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAINE",
        "first_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "RI",
            "license": "12523",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "196273-1",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CT",
            "license": "39067",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CT",
            "license": "039067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CT MEDICARE NUMBER",
            "identifier": "200001063",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tblaine109313@direct.HSS.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.