THEOPHANY ANNE CRUZAT BLANCO MD
NPI 1477135390
Student in an Organized Health Care Education/Training Program in Brooklyn, NY
About Theophany Anne Cruzat Blanco Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
THEOPHANY ANNE CRUZAT BLANCO MD (NPI 1477135390) is an individual student in an organized health care education/training program in Brooklyn, New York and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
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
Theophany Anne Cruzat Blanco Md 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.
Medicare Billing Reassignment
Medicare enrollment records show Theophany Anne Blanco reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Diego, CA 92120
- Reassigned Medicare billing, California enrollment
- 13,921 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
BROOKLYN, NY 11219
BROOKLYN, NY 11219
BROOKLYN, NY 11219
BROOKLYN, NY 11219
BROOKLYN, NY 11219
BROOKLYN, NY 11219
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 Theophany Anne Blanco's NPI number?
The NPI number for Theophany Anne Blanco is 1477135390. It was assigned to this individual provider in the NPPES registry on April 21, 2021.
Where is Theophany Anne Blanco located?
Theophany Anne Blanco practices at 4802 10th Ave, Brooklyn, NY 11219. The listed phone number is (718) 283-6000.
What is Theophany Anne Blanco's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Theophany Anne Blanco enrolled in Medicare?
Yes. Theophany Anne Blanco 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 Theophany Anne Blanco's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Theophany Anne Blanco reassigns Medicare benefits to Southern California Permanente Medical Group (San Diego, CA). 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 Theophany Anne Blanco'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 Theophany Anne Blanco was last updated on April 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.
# Theophany Anne Cruzat Blanco, MD · NPI 1477135390
Student in an Organized Health Care Education/Training Program provider in Brooklyn, New York. Individual provider, active in the CMS NPPES registry since April 21, 2021.
## Identity
- **NPI:** 1477135390 (Entity type: Individual)
- **Enumerated:** April 21, 2021
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4802 10TH AVE, Brooklyn, NY 11219-2916
- **Phone:** (718) 283-6000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Southern California Permanente Medical Group (NPI 1225060742, San Diego, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** April 21, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1477135390) · Data from the CMS NPPES public registry.