| Blaine S Kristo, MD | |
|
1348 S 18th St Ste 230, Fernandina Beach, FL 32034-4785 | |
| (904) 277-2003 | |
| (904) 376-3271 |
| Full Name | Blaine S Kristo |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 27 Years |
| Location | 1348 S 18th St Ste 230, Fernandina Beach, Florida |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124128822 | NPI | - | NPPES |
| 572702-01 | Medicaid | HI | |
| 0000253955 | Other | HI | HMSA BILLING NUMBER |
| 118728900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | ME159017 (Florida) | Primary |
| 208800000X | Urology | MD-13190 (Hawaii) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Accentcare Home Health Of Jacksonville | Orange park, FL | Home health agency |
| Baptist Medical Center - Nassau | Fernandina beach, FL | Hospital |
| Baptist Health Medical Center - Jacksonville | Jacksonville, FL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Baptist Urology Inc | 6709029614 | 3 |
| Entity Name | Baptist Urology Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689011710 PECOS PAC ID: 6709029614 Enrollment ID: O20130826000082 |
| Mailing Address | Practice Location Address |
|---|---|
| Blaine S Kristo, MD Po Box 746643, Atlanta, GA 30374-6643 Ph: (904) 202-2092 | Blaine S Kristo, MD 1348 S 18th St Ste 230, Fernandina Beach, FL 32034-4785 Ph: (904) 277-2003 |
Margeaux Jenee Dennis, DO Urology Medicare: Accepting Medicare Assignments Practice Location: 1348 S 18th St Ste 230, Fernandina Beach, FL 32034 Phone: 904-277-2003 Fax: 904-277-2006 | |
Kenneth A Son, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 1348 S 18th St, Fernandina Beach, FL 32034 Phone: 904-227-2003 Fax: 904-277-2006 |