MR. JACK COLT BLAINE (CRNA) – Certified Registered Nurse Anesthetist, NPI 1811999642
Certified Registered Nurse Anesthetist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,456 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in CA
Provider Addresses for MR. JACK COLT BLAINE (CRNA)
1788 ZAFIRO CT
PALM SPRINGS, CA 922646808
Phone: (619) 994-2941
Type: Mailing
36720 PALM CT
RANCHO MIRAGE, CA 922702206
Phone: (619) 994-2941
Type: Mailing
6709 ACADEMY RD NE STE A
ALBUQUERQUE, NM 871093363
Phone: (505) 312-4712
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-09-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20060103000855 | I | Certified Registered Nurse Anesthetist (Crna) | CA | TBD |
| I20070911000418 | I | Certified Registered Nurse Anesthetist (Crna) | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 00811 | Anesthesia for other procedure on large bowel using an endoscope | 205 | 202 | $0 |
| 00731 | Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope | 84 | 81 | $0 |
| 00813 | Anesthesia for procedure on small and large bowel using an endoscope | 58 | 58 | $0 |
| 00812 | Anesthesia for exam of colon using an endoscope | 30 | 30 | $0 |
Insurance plans in this area (ZIP 92264)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | AZ | |
| - | AZ | |
| General Surgery | AZ | |
| O B S T E T R I C S/ G Y N E C O L O G Y | AZ | |
| Certified Nurse Midwife (Cnm) | AZ | |
| Cardiac Surgery, Thoracic Surgery | AZ | |
| Cardiovascular Disease (Cardiology) | AZ | |
| Otolaryngology, Otolaryngology, Allergy/Immunology | CO | |
| Internal Medicine, Hematology/Oncology, Hematology/Oncology | ND | |
| Nurse Practitioner | AZ |
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