Kendrick David Blais, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AA2242 Issued in AK

Practice address

1867 Airport Way Ste 140a
Fairbanks, AK 99701-4055

Phone

(907) 457-9355

Fax

(907) 457-9356

NPI assigned

Jul 14, 2006

Last updated

Oct 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 AK

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, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tanana Valley Clinic LLCGroup PAC ID 5698056901, 142 clinicians

Polar Wind Medical Center IncGroup PAC ID 8820082746, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospice Services Hospice, Fairbanks, AK, CCN 021507
• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012
• Denali Center Nursing home, Fairbanks, AK, CCN 025020

Merit-based Incentive Payment System (MIPS)

Final score

92.86 of 100Reported as group

Quality

94.88

Promoting interoperability

100

Improvement activities

40

Cost

79.39

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/dacaffe7-8a80-45f7-8229-32bd110ee86a/
• Direct secure messaging: kendrick.blais@polarwind.cernerdirect.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Denali Center, LLC

  • Skilled Nursing Facility
  • Fairbanks, AK
  • NPI 1326597410

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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.

• Polar Wind Medical Center, Inc.

  • Family Medicine Physician
  • Fairbanks, AK
  • NPI 1013933209
  Medicare reassignment Care Compare group NPD Authorized official
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1922559558
  Medicare reassignment Care Compare group NPD
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1073081485
  NPD
• Denali Center, LLC

  • Skilled Nursing Facility
  • Fairbanks, AK
  • NPI 1326597410
  NPD (past)

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

• Denali Center, LLC

  • Skilled Nursing Facility
  • Fairbanks, AK
  • NPI 1326597410

  Nursing home

  Care Compare affiliation
• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation
• Fairbanks Memorial Hospital, LLC

  • Community Based Hospice Care Agency
  • Fairbanks, AK
  • NPI 1881145571
  Care Compare affiliation

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1497771109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY STE 140A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014055",
            "telephone_number": "907-457-9355",
            "fax_number": "907-457-9356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY STE 140A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014055",
            "telephone_number": "907-457-9355",
            "fax_number": "907-457-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIS",
        "first_name": "KENDRICK",
        "middle_name": "DAVID",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "AA2242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derrick Blackburn
• Karen R Blackburn
• Wendy Ann Blackwell
• Candace Alexis Blackwood, MS
• Ryan Blair
• Jamie Blalock
• Anthony Lee Blanford, M.D.
• Cherri Blaska
• Cyruss John Wane Blewett
• Taryn E Bliss, RD, LD

• Family Medicine Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.