Look up the most recent NPI and PECOS records

Blair Dorn

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

1635 E Myrtle Ave, Phoenix, AZ 85020-5556

PECOS Enrollment

Based on the most recent information from CMS, provider Blair Dorn is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1427542059
Provider Type
Individual
Full Name
Dorn, Blair
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
6/18/2018
Last Updated
1/23/2025

Contact Information

Practice Location

1635 E Myrtle Ave, Phoenix, AZ 85020-5556

(026) 944-2900

Unlisted Fax

Mailing Location

1635 E Myrtle Ave, Phoenix, AZ 85020-5556

(026) 944-2900

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 2120853	Description Medicaid	Issuer Unlisted Washington

Blair Dorn

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Vacco, Alaina Anne

Mintz, Rose Marie

Mussman, Pooneh

Lalio, Denise Alisha

Migdal, Talor

Beaumont, Julie

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Salmi, Kristen

Allison, Crystal Dawn

Underwood, Kooper Harrison