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DR. BLAZE KELLY DO
NPI 1003445842
Anesthesiology - Pain Medicine in Bridgeport, CT

Active since April 03, 2020PECOS EnrolledAccepts Medicare Assignment
267 GRANT ST, BRIDGEPORT, CT 06610(203) 384-3000(203) 384-4108 Get Directions Write a Review

NPPES record last updated: May 16, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 16, 2025, Apr 3, 2020 (2 updates tracked since 2020).

About Dr. Blaze Kelly Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BLAZE KELLY DO (NPI 1003445842) is an individual pain medicine provider in Bridgeport, Connecticut, licensed in Connecticut (81122) and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in Philadelphia, and is a graduate of Lake Erie College Of Osteopathic Medicine, Erie (2020).

NPPES Registry Identity

NPI1003445842
Entity TypeIndividualMale
Primary Taxonomy207LP2900X
Provider Legal NameDR. BLAZE KELLYCredential: DO
Location Address267 GRANT STBridgeport, CT 06610-2805
Mailing Address111 S 11th St Ste 8290Philadelphia, PA 19107-4824 · (215) 955-2370 · Fax (215) 955-0677
Phone(203) 384-3000
Fax(203) 384-4108
Sole ProprietorNo
Medical School CMSLake Erie College Of Osteopathic Medicine, ErieGraduated 2020
Enumeration DateApril 3, 2020
Last NPPES UpdateMay 16, 20252 updates tracked since enumeration
NPPES CertifiedMay 16, 2025
✔ NPI 1003445842 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAnesthesiology · Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207LP2900X
License✔ Licensed in CT · 81122
Definition
An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License OT019937 (PA)
267 GRANT ST, Bridgeport, CT 06610
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Secondary Practice Location 1

Location 1111 S 11th St Ste 8290Philadelphia, PA 19107-4824 · Phone (215) 955-2370 ext. 21595 · Fax (215) 955-0677

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Blaze Kelly Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7214368307
PECOS Enrollment IDI20250530001653
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Blaze Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Yale University
14 mi
Advanced Practice Midwife
100 CHURCH ST S STE 200, YALE SCHOOL OF NURSING
New Haven, CT 06519
  • Reassigned Medicare billing, Connecticut enrollment
  • 3,728 clinicians in this Medicare group
NPI 1124148887 (203) 737-5432
University Of Penn - Medical Group
120 mi
Thoracic Surgery (Cardiothoracic Vascular Surgery)
595 W STATE ST STE 207
Doylestown, PA 18901
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 3,488 clinicians in this Medicare group
NPI 1538056163 (215) 345-2100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Anesthesia for procedure for total knee joint replacement 01402
Anesthesia for a total knee joint replacement numbs your body to eliminate pain during surgery. This could be general anesthesia where you're unconscious, or regional anesthesia where only the leg is numb. It's administered by a specialist, ensuring safety and comfort.
12 services12 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. ALEX SCOTT CADAN PA-C
Physician Assistant (Surgical)
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-4500
RYAN KEENAN PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-3000
KARINA K. LINCER
Physical Therapist
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-3000
DOROTHY D. DAPONTE
Physical Therapy Assistant
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-3000
MISS SANDRA SHIPKOWITZ APRN
Nurse Practitioner (Pediatrics)
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-4490
HOLLY S. ASHBY
Physical Therapist
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-3000
TESSA GURALNICK DPT
Physical Therapist
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 384-3708
PATRICIA ANNE SIMPSON APRN
Nurse Practitioner (Psychiatric/Mental Health)
267 GRANT ST
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 368-3000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blaze Kelly's NPI number?

The NPI number for Blaze Kelly is 1003445842. It was assigned to this individual provider in the NPPES registry on April 3, 2020.

Where is Blaze Kelly located?

Blaze Kelly practices at 267 Grant St, Bridgeport, CT 06610. The listed phone number is (203) 384-3000.

What is Blaze Kelly's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Pain Medicine, with taxonomy code 207LP2900X.

Is Blaze Kelly enrolled in Medicare?

Yes. Blaze Kelly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Blaze Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Blaze Kelly reassigns Medicare benefits to 2 organizations: Yale University (New Haven, CT) and University Of Penn - Medical Group (Doylestown, PA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Blaze Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Blaze Kelly was last updated on May 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.