NPIMap

Organization Active NPI

Longview Orthopedic Associates, PLLC

  • Orthopaedic Surgery Physician
  • Longview, WA
National Provider Identifier
1003865072
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
LONGVIEW ORTHOPEDIC ASSOCIATES, PLLC
Practice address
625 - 9TH Ave.
Ste. 210
Longview, WA 98632-2465
Phone
(360) 501-3400
Fax
(360) 423-6862
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce Gragg Blackstone, MD
Title
Owner Partner
Phone
(360) 501-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

625 - 9TH Ave.
Ste. 210
Longview, WA 98632-2465

Mailing address

625 - 9TH Ave.
Ste. 210
Longview, WA 98632-2465
Phone (360) 501-3400

Other identifiers 5

IdentifierTypeStateIssuer
0198037OtherWALABOR & INDUSTRIES
7127632MedicaidWA
269896MedicaidOR
DD4041OtherWARAILROAD MEDICARE
5445810001OtherWACIGNA DME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050805000452 WA Part B Supplier - Clinic/Group Practice 7315976792 Receives reassigned benefits from 16 practitioners
Practice locations: Longview, WA

National Provider Directory

National Provider Directory

Locations

7 Medical Plaza Dr
Fl 4
Roseville, CA 95661

1615 Delaware St
Ste G1
Longview, WA 98632
Phone (360) 501-3400

625 9th Ave
Ste 130
Longview, WA 98632

Networks

  • devoted network organization-54bc88f0-8c1c-41b6-b022-755ebfe4d22c

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1003865072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 - 9TH AVE.",
            "address_2": "STE. 210",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322465",
            "telephone_number": "360-501-3400",
            "fax_number": "360-423-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 - 9TH AVE.",
            "address_2": "STE. 210",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322465",
            "telephone_number": "360-501-3400",
            "fax_number": "360-423-6862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGVIEW ORTHOPEDIC ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "BLACKSTONE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "GRAGG",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "360-501-3400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0198037",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7127632",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269896",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD4041",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DME",
            "identifier": "5445810001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.