Blaise Fortunata, PSYCHOLOGIST

Key facts

NPI

1609816636

Entity type

Individual (NPI type 1)

Primary specialty

Psychologist 103T00000X

License

8563 (MA)

Practice address

460 W Main St
Hyannis, MA 02601-3855

Phone

(508) 790-3360

Fax

(508) 790-3378

NPI assigned

Jun 7, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 4

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.

• Permanente Medical Group Inc Internal Medicine Physician · Santa Clara, CA · NPI 1073606299
  Medicare reassignment NPD CA
• Permanente Medical Group Inc Internal Medicine Physician · Stockton, CA · NPI 1548343510
  NPD
• Permanente Medical Group, Inc Clinical Medical Laboratory · San Jose, CA · NPI 1497971584
  NPD
• Cape Cod Healthcare Inc. Mental Health Clinic/Center (Including Community Mental Health Center) · Hyannis, MA · NPI 1245286152
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 30, 2021.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1609816636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 W MAIN ST",
            "city": "HYANNIS",
            "state": "MA",
            "postal_code": "026013855",
            "telephone_number": "508-790-3360",
            "fax_number": "508-790-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 W MAIN ST",
            "city": "HYANNIS",
            "state": "MA",
            "postal_code": "026013855",
            "telephone_number": "508-790-3360",
            "fax_number": "508-790-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTUNATA",
        "first_name": "BLAISE",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "8563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "800 Sereno Dr",
            "city": "Vallejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945892411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hyannis, MA

• Joanne Marie Ford, RN MBA BSN
• Forever Care Home Health Services LLC
• Lisa Michele Forman, M.S.
• Bamby Forrest, RN
• Eric Fortier, PA-C
• Frank L Fortunato Jr., MD
• Thelma Sloane Foster, R.N.
• Amelia E Fournier, AHNP
• Laurel E Fournier
• Leila Suzanne Frangieh, NP

All providers in Hyannis, MA · Psychologist in Massachusetts