Kendrick David Blais, D.O.
Individual provider Active NPI Family Medicine Physician · Fairbanks, AK
NPI 1497771109 · NPPES record last updated Oct 7, 2022
Key facts
- NPI
- 1497771109
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- AA2242 (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
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tanana Valley Clinic LLC
Polar Wind Medical Center Inc
Practice addresses (Care Compare)
1650 Cowles St
Fairbanks, AK 99701-5907
Phone (907) 459-3500
1867 Airport Way
Suite 140a
Fairbanks, AK 99701-4055
Phone (907) 457-9355
Hospital & facility affiliations
- Fairbanks Memorial Hospital Hospice Services
- Fairbanks Memorial Hospital
- Denali Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.86 of 100
- Quality
- 94.88
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 79.39
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Denali Center |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Nov 1, 2022 Feb 20, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101201001410 | AK | Practitioner - Family Practice | 4880688605 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA2242 | AK | MD | Family Medicine Physician |
| 2292 | AK | MD | Pain Medicine (Physical Medicine & Rehabilitation) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Polar Wind Medical Center, Inc. | Family Medicine | Current |
Accepting new patients |
| Tanana Valley Clinic LLC | Current |
Accepting new patients | |
| Tanana Valley Clinic LLC | Current |
Accepting new patients | |
| Denali Center, LLC | Past | Accepting new patients |
Locations
1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181
1867 Airport Way
Ste 140A
Fairbanks, AK 99701
Phone (907) 457-9355
1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806
Interoperability endpoints
- kendrick.blais@polarwind.cernerdirect.com
- https://fhir-myrecord.cerner.com/r4/dacaffe7-8a80-45f7-8229-32bd110ee86a/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | AA2242 | AK | Yes |
Addresses
Primary practice location
1867 Airport Way Ste 140a
Fairbanks, AK 99701-4055
Mailing address
1867 Airport Way Ste 140a
Fairbanks, AK 99701-4055
Phone (907) 457-9355
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DO43111 | Medicaid | AK |
Other providers in Fairbanks, AK
- Derrick Blackburn
- Karen R Blackburn
- Wendy Ann Blackwell
- Candace Alexis Blackwood
- Ryan Blair
- Jamie Blalock
- Anthony Lee Blanford
- Cherri Blaska
- Cyruss John Wane Blewett
- Taryn E Bliss
All providers in Fairbanks, AK · Family Medicine Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.