Active NPI
Christopher Kynrint Blazes, MD
- Psychiatry Physician
- Portland, OR
National Provider Identifier
1568449916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD203430
- Practice address
- 3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964 - Phone
- (503) 220-8262
- NPI assigned
- Dec 28, 2005
- Last updated
- May 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD073837L | PA | |
| Emergency Medicine Physician | 207P00000X | C140172 | CA | |
| Emergency Medicine Physician | 207P00000X | 4301115779 | MI | |
| Neurology Physician | 2084N0400X | 4301115779 | MI | |
| Psychiatry Physician | 2084P0800X | 4301115779 | MI | |
| Addiction Psychiatry Physician | 2084P0802X | 4301115779 | MI | |
| Psychiatry Physician | 2084P0800X | MD203430 | OR | Primary |
Addresses
Primary practice location
3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964
Mailing address
2626 SW Sherwood PL
Portland, OR 97201-2285
Phone (215) 313-9651
Other practice location 1
4250 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 764-6443
Other practice location 2
1200 Old York Rd
Abington, PA 19001
Phone (215) 481-4355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018495650001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C140172 | CA | MD | Emergency Medicine Physician |
| MD073837L | PA | MD | Emergency Medicine Physician |
| MD203430 | OR | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653350400000",
"number": "1568449916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2626 SW SHERWOOD PL",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972012285",
"telephone_number": "215-313-9651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392964",
"telephone_number": "503-220-8262"
}
],
"practiceLocations": [
{
"address_1": "4250 Plymouth Rd",
"address_purpose": "LOCATION",
"city": "Ann Arbor",
"state": "MI",
"postal_code": "481092700",
"country_code": "US",
"telephone_number": "734-764-6443",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1200 Old York Rd",
"address_purpose": "LOCATION",
"city": "Abington",
"state": "PA",
"postal_code": "19001",
"country_code": "US",
"telephone_number": "215-481-4355",
"fax_number": "215-481-4629",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLAZES",
"first_name": "CHRISTOPHER",
"middle_name": "KYNRINT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2022-05-24",
"certification_date": "2022-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "PA",
"license": "MD073837L",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "C140172",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4301115779",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "4301115779",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301115779",
"primary": false
},
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "MI",
"license": "4301115779",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OR",
"license": "MD203430",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018495650001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.