NPIMap

Individual provider Active NPI

Kirk David Blais

  • Internal Medicine Physician
  • Manchester, CT
National Provider Identifier
1437593803
Registry record updated Apr 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0059214 Issued in CO
Practice address
71 Haynes St
Manchester, CT 06040-4131
Phone
(860) 533-6559
Fax
(860) 533-6571
NPI assigned
Apr 29, 2013
Last updated
Apr 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0059214 CO Primary

Addresses

Primary practice location

71 Haynes St
Manchester, CT 06040-4131

Mailing address

71 Haynes St
Manchester, CT 06040-4131
Phone (860) 533-6559

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20170926000914 CO Practitioner - Internal Medicine 3072824648 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Internal Medicine Current Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Sep 5, 2025 Accepting new patients
St Mary's Hospital and Medical Center, Inc Internal Medicine Current Accepting new patients
Intermountain Medical Group Grand Junction, LLC Internal Medicine Current Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Nov 1, 2020 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Sep 5, 2025 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Nov 1, 2020 Accepting new patients
St Mary's Hospital and Medical Center, Inc CurrentSince Sep 1, 2017 Accepting new patients
St Mary's Hospital and Medical Center, Inc CurrentSince Sep 1, 2017 Accepting new patients
Intermountain Front Range, Inc. Past Accepting new patients

Locations

500 Eldorado Blvd
Ste 6300
Broomfield, CO 80021
Phone (303) 272-0803

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

2635 N 7th St
Grand Junction, CO 81501
Phone (970) 244-2009

2635 N 7th St
Ste 4205
Grand Junction, CO 81501
Phone (970) 298-7049

Organizations & group practices 10

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.

Hospital & facility affiliations 9

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": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1437593803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-533-6559",
            "fax_number": "860-533-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-533-6559",
            "fax_number": "860-533-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIS",
        "first_name": "KIRK",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-29",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0059214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.