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TRYSTAN BLAKE DO
NPI 1275114753
Family Medicine in Middletown, NY

Active since April 16, 2021PECOS EnrolledAccepts Medicare Assignment
707 E MAIN ST, MIDDLETOWN, NY 10940(845) 333-7373 Get Directions Write a Review

NPPES record last updated: November 26, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Trystan Blake Do NPPES

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

TRYSTAN BLAKE DO (NPI 1275114753) is an individual family medicine provider in Middletown, New York, licensed in Utah (13772735-1204) and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS, is affiliated with Holy Cross Hospital - Salt Lake, and maintains a secondary practice location in Salt Lake City.

NPPES Registry Identity

NPI1275114753
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameTRYSTAN BLAKECredential: DO
Location Address707 E MAIN STMiddletown, NY 10940-2650
Mailing Address707 E Main StMiddletown, NY 10940-2650
Phone(845) 333-7373
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 16, 2021
Last NPPES UpdateNovember 26, 2024
NPPES CertifiedNovember 26, 2024
✔ NPI 1275114753 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in UT · 13772735-1204
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
707 E MAIN ST, Middletown, NY 10940
Open in Google Maps ↗

Secondary Practice Location 1

Location 182 S 1100 E Ste 403Salt Lake City, UT 84102-1892 · Phone (801) 505-5299 · Fax (801) 350-4753

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, University of Utah Health Plans.Insurance ›

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

Trystan Blake 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 ID4880129758
PECOS Enrollment IDI20241202001905
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 Trystan Blake reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Catholic Health Initiatives Colorado
1,926 mi
Orthopaedic Surgery
2200 PARK AVE STE D100
Park City, UT 84060
  • Reassigned Medicare billing, Utah enrollment
  • 136 clinicians in this Medicare group
NPI 1326741232 (801) 533-2002

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

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Holy Cross Hospital - Salt Lake

Acute Care Hospitals · Salt Lake City, UT
2/5 CMS rating
OwnershipProprietary
CMS Certification Number460003
Location1050 East South TempleSalt Lake City, UT 84102 · Salt Lake County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10940 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$95.99 typical visit price
range $61.88 – $187.05
Typical copayment $23.99 (range $15.47 – $46.76)
Most-billed visit code 99203
Established Patient
$108.56 typical visit price
range $19.92 – $151.94
Typical copayment $27.14 (range $4.98 – $37.98)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

KRASSIMIR ATANASSOV MD
Surgery (Surgical Critical Care)
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-7575
DR. AAMIR MASOOD GILANI M.D
Internal Medicine (Pulmonary Disease)
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-7575
HAALA BABAR DO
Emergency Medicine
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-7373
DR. ERINI ANDREAS CHRISTODOULOU MD
Student in an Organized Health Care Education/Training Program
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-7373
TETYANA KOCHETKOVA
Dietitian, Registered
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-1000
MR. BRIGHT BOAFO NKRUMAH PA
Physician Assistant (Medical)
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-1114
FRANK CHIDI OGBONNA MD/DO
Radiology (Radiation Oncology)
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-1000
DUSTIN BATTAD MD
Student in an Organized Health Care Education/Training Program
707 E MAIN ST
MIDDLETOWN, NY 10940
Orange County (845) 333-7373

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 Trystan Blake's NPI number?

The NPI number for Trystan Blake is 1275114753. It was assigned to this individual provider in the NPPES registry on April 16, 2021.

Where is Trystan Blake located?

Trystan Blake practices at 707 E Main St, Middletown, NY 10940. The listed phone number is (845) 333-7373.

What is Trystan Blake's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Trystan Blake enrolled in Medicare?

Yes. Trystan Blake 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 Trystan Blake's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Trystan Blake reassigns Medicare benefits to Catholic Health Initiatives Colorado (Park City, UT). 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 Trystan Blake's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Trystan Blake accept?

Health plans from Molina Healthcare and University of Utah Health Plans list Trystan Blake as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Trystan Blake affiliated with any hospitals?

According to CMS data, Trystan Blake is affiliated with Holy Cross Hospital - Salt Lake.

When was this NPI record last updated?

The NPPES record for Trystan Blake was last updated on November 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.