Brice William Blatz, MD, MS

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301092779 Issued in MI

Practice address

221 Michigan St NE
Grand Rapids, MI 49503-2543

Phone

(616) 391-1405

Fax

(616) 391-8611

NPI assigned

Jun 25, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 22, 2024 through Nov 22, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: brice.blatz.1@32699.direct.athenahealth.com

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.

• Pacific Regenerative and Interventional Sports Medicine

  • Medical Specialty Clinic/Center
  • San Jose, CA
  • NPI 1952857823
  NPD (past) Authorized official
• Prism

  • Ambulatory Surgical Clinic/Center
  • San Jose, CA
  • NPI 1568837060
  NPD (past) Authorized official

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1770745309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9925 SW NIMBUS AVE",
            "address_2": "STE 100",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970087591",
            "telephone_number": "503-217-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032543",
            "telephone_number": "616-391-1405",
            "fax_number": "616-391-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLATZ",
        "first_name": "BRICE",
        "middle_name": "WILLIAM",
        "credential": "MD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NV",
            "license": "LL2132",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301092779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REG. MEDICAL LIC.",
            "identifier": "LL2132",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Alice Walker Blanker, LMSW, CAADC, ADS
• Kendall Blanton
• Chloe Blanzy, RN
• Denise Renee Blaser-Gohsman, A.A.S., C.B.I.S.
• Serena Blasko, BEHAVIOR TECHNICIAN
• Natalie J Blauer, LMSW
• Mary Elizabeth Blauw, FNP
• Brody Blaylock
• Kathleen K Blazek, MD
• Ivan Blehinger

• Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.