Individual provider Active NPI

Gerold J Blazek, MD

  • Anesthesiology Physician
  • Albuquerque, NM
National Provider Identifier
1467452664
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
86-176 Issued in NM
Practice address
4401 Masthead St NE
Suite 120
Albuquerque, NM 87109-4327
Phone
(505) 243-7729
Fax
(505) 243-4804
NPI assigned
Jul 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 86-176 NM Primary

Addresses

Primary practice location

4401 Masthead St NE
Suite 120
Albuquerque, NM 87109-4327

Mailing address

PO Box 36840
Albuquerque, NM 87176-6840
Phone (505) 243-7729

Other identifiers 1

IdentifierTypeStateIssuer
37812MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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

Enrollment IDStateProvider typePAC IDDetails
I20101112000445 NM Practitioner - Anesthesiology 7719172048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Anesthesia of New Mexico, LLCGroup PAC ID 3476807538, 228 clinicians

Practice addresses (Care Compare)

601 Dr Martin Luther King Jr Ave NE
Lovelace Medical Center
Albuquerque, NM 87102-3619
Phone (505) 727-8000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Main Street Anesthesia of New Mexico, LLC Anesthesiology CurrentSince Jan 1, 2019 Accepting new patients
Ophthalmic Anesthesia Services Anesthesiology Past Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

601 Martin Luther King Ave NE
Albuquerque, NM 87102
Phone (505) 727-8040

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

Organizations & group practices 3

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 3

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": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313712000000",
    "number": "1467452664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36840",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871766840",
            "telephone_number": "505-243-7729",
            "fax_number": "505-243-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 MASTHEAD ST NE",
            "address_2": "SUITE 120",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094327",
            "telephone_number": "505-243-7729",
            "fax_number": "505-243-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZEK",
        "first_name": "GEROLD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2011-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NM",
            "license": "86-176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37812",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.