DR. DANICE BLAISE MD,MBA
NPI 1255829966
General Practice in Lake Wales, FL

Q: What is Danice Blaise's NPI number?

The NPI number for Danice Blaise is 1255829966. It was assigned to this individual provider in the NPPES registry on April 27, 2018.

Q: What is Danice Blaise's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Danice Blaise was last updated on December 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.

Active since April 27, 2018PECOS EnrolledAccepts Medicare Assignment

684 STATE ROAD 60 W, LAKE WALES, FL 33853(863) 949-4868(863) 223-8549 Get Directions Write a Review

NPPES record last updated: December 7, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 7, 2024, Oct 27, 2022, Sep 23, 2020 and 2 more (5 updates tracked since 2018).

On this page

About Dr. Danice Blaise Md,mba NPPES

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

DR. DANICE BLAISE MD,MBA (NPI 1255829966) is an individual general practice provider in Lake Wales, Florida, licensed in Florida (ACN1418) and active in the NPI registry since April 2018. He is enrolled in Medicare PECOS, maintains a secondary practice location in Winter Haven, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1255829966

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameDR. DANICE BLAISECredential: MD,MBA

Location Address684 STATE ROAD 60 WLake Wales, FL 33853-4419

Mailing Address6675 Westwood Blvd Ste 475Orlando, FL 32821-6027 · (407) 845-0330 · Fax (888) 972-1752

Phone(863) 949-4868

Fax(863) 223-8549

Sole ProprietorYes

Medical School CMSOtherGraduated 2017

Enumeration DateApril 27, 2018

Last NPPES UpdateDecember 7, 20245 updates tracked since enumeration

NPPES CertifiedDecember 7, 2024

✔ NPI 1255829966 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in FL · ACN1418

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedInternal MedicineTaxonomy 207R00000X · License 25173 (NH)

Also ListedPhysician AssistantTaxonomy 363A00000X · License 2019045102 (MO), CV2000213 (IN)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

684 STATE ROAD 60 W, Lake Wales, FL 33853

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Secondary Practice Location 1

Location 1571 Avenue K SEWinter Haven, FL 33880-4215 · Phone (407) 440-0708 · Fax (407) 357-0347

Other Identifiers 1

Medicaid115752400FL

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. Danice Blaise Md,mba 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 ID1355738899

PECOS Enrollment IDI20220502000035

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 Reassignment

Medicare enrollment records show Danice Blaise reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

The Center For Functional Aesthetic And Anti Aging Medicine Inc

11 mi

Internal Medicine

571 AVENUE K SE
Winter Haven, FL 33880

Reassigned Medicare billing, Florida enrollment

NPI 1508682089 (407) 440-0708

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

37 services11 patients

Other Providers at the Same Location NPPES 4

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

NATASHA L FENELON APRN

Nurse Practitioner (Family)

684 STATE ROAD 60 W
LAKE WALES, FL 33853

Polk County (863) 949-4868

YAIRALIZ RODRIGUEZ GONZALEZ

General Practice

684 STATE ROAD 60 W
LAKE WALES, FL 33853

Polk County (863) 949-4868

MEDICAL HOME ALLIANCE LLC

Internal Medicine

684 STATE ROAD 60 W
LAKE WALES, FL 33853

Polk County (863) 949-4868

JORGE ELIECER SARA OCHOA MD

General Practice

684 STATE ROAD 60 W
LAKE WALES, FL 33853

Polk County (863) 949-4868

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 Danice Blaise's NPI number?

The NPI number for Danice Blaise is 1255829966. It was assigned to this individual provider in the NPPES registry on April 27, 2018.

Where is Danice Blaise located?

Danice Blaise practices at 684 State Road 60 W, Lake Wales, FL 33853. The listed phone number is (863) 949-4868.

What is Danice Blaise's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Danice Blaise enrolled in Medicare?

Yes. Danice Blaise 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 organization bills Medicare for Danice Blaise's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Danice Blaise reassigns Medicare benefits to The Center For Functional Aesthetic And Anti Aging Medicine Inc (Winter Haven, FL). The 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 Danice Blaise'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 Danice Blaise was last updated on December 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.