Phillip Wayne Blaich, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9103668 Issued in FL

Practice address

300 Twining St BLDG 760
Maxwell Afb, AL 36112-6027

Phone

(334) 953-8607

Fax

(850) 747-2222

NPI assigned

Apr 24, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Panhandle Emergency Physicians a Div of Sacred Heart Hosp Pensacola

  • Emergency Medicine Physician
  • Pensacola, FL
  • NPI 1215948096
  Medicare reassignment

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1861458424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 TWINING ST BLDG 760",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "361126027",
            "telephone_number": "334-953-8607",
            "fax_number": "850-747-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 TWINING ST BLDG 760",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "361126027",
            "telephone_number": "334-953-8607",
            "fax_number": "850-747-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAICH",
        "first_name": "PHILLIP",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085003348",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020471300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J Calvin Anderson
• Sara Bagorio, RDH
• Valeri Marie Bennett, MSW, LCSW
• Lydia Price Beringer, M.S CCC/SLP
• Erlinda Padua Bhat, N.P.
• Christine Sirna Bode
• Rebecca Katherine Brincks, DDS
• Heather Marie Brooks, DDS
• Megan Bryant
• John Campbell Jr.

• Medical Physician Assistant in Maxwell Afb, AL
• Providers in Maxwell Afb, AL by specialty
• Medical Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.