BLUETAIL MEDICAL GROUP, LLC. – Sports Medicine (Orthopaedic Surgery) Physician, NPI 1285986398
Sports Medicine (Orthopaedic Surgery) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for BLUETAIL MEDICAL GROUP, LLC.
PO BOX 11665
BELFAST, ME 049154007
Phone: (636) 778-2900
Fax: (636) 778-2828
Type: Mailing
13353 OLIVE BLVD
CHESTERFIELD, MO 630173108
Phone: (636) 778-2900
Fax: (636) 778-2828
Type: Location
101 Hodencamp Rd Ste 102
Thousand Oaks, CA 913605831
Phone: (636) 778-2900
Type: Location
36 Old Kings Hwy S Ste 105
Darien, CT 068204523
Phone: (636) 778-2900
Type: Location
1875 Veterans Park Dr Ste 2201
Naples, FL 341090596
Phone: (239) 631-1960
Fax: (239) 631-5967
Type: Location
17300 N OUTER 40 RD
SUITE 201
CHESTERFIELD, MO 630051375
Phone: (636) 778-2900
Fax: (636) 778-2828
Type: Location
160 Westmount Dr
Farmington, MO 636402970
Phone: (636) 778-2900
Type: Location
1575 Lookout Dr
North Mankato, MN 560032503
Phone: (636) 778-2900
Type: Location
2807 W Broadway Ste 107
Columbia, MO 652031317
Phone: (636) 778-2900
Type: Location
516 E State Road 32
Westfield, IN 460748767
Phone: (636) 778-2900
Type: Location
3852 Creamery Rd
DE Pere, WI 541159210
Phone: (636) 778-2900
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: 2013-08-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| O20130828000660 | O | Clinic/Group Practice | MO | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 04915)
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