Blaise Fondren, - Medicare Nurse Practitioner in Memphis, TN

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Blaise Fondren, is a medicare enrolled "Nurse Practitioner - Family" in Memphis, Tennessee. Her current practice location is 6401 Poplar Ave, Memphis, Tennessee. You can reach out to her office (for appointments etc.) via phone at (901) 525-3086.

Blaise Fondren is licensed to practice in Tennessee (license number 36596) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1679341630.

Contact Information

Blaise Fondren,
6401 Poplar Ave,
Memphis, TN 38119-4823
(901) 525-3086
Not Available

Map and Direction




Provider's Profile

Full NameBlaise Fondren
GenderFemale
SpecialityNurse Practitioner - Family
Location6401 Poplar Ave, Memphis, Tennessee
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1679341630
  • Provider Enumeration Date: 12/19/2023
  • Last Update Date: 10/03/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 2062851264
  • Enrollment ID: I20240422000485

Medical Identifiers

Medical identifiers for Blaise Fondren such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1679341630NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163W00000XRegistered Nurse 899036 (Mississippi)Secondary
363LF0000XNurse Practitioner - Family 906484 (Mississippi)Secondary
363LF0000XNurse Practitioner - Family 36596 (Tennessee)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Blaise Fondren allows following entities to bill medicare on her behalf.
Entity NameYalobusha General Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1740380914
PECOS PAC ID: 4486601648
Enrollment ID: O20050331000530

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Blaise Fondren is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Blaise Fondren,
420 Live Oak Dr,
Oxford, MS 38655-2962

Ph: (901) 337-5548		Blaise Fondren,
6401 Poplar Ave,
Memphis, TN 38119-4823

Ph: (901) 525-3086

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.