Active NPI
Angela Sue Fornkohl Blum, M.D.
- Pediatrics Physician
- New Castle, IN
National Provider Identifier
1013032325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 01063222A
- Practice address
- 1000 N 16TH St
Suite G-10
New Castle, IN 47362-4319 - Phone
- (765) 521-0901
- Fax
- (765) 521-9891
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01063222A | IN | Primary |
Addresses
Primary practice location
1000 N 16TH St
Suite G-10
New Castle, IN 47362-4319
Mailing address
PO Box 426
New Castle, IN 47362-0426
Phone (765) 521-0901
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000519955 | Other | IN | ANTHEM |
| 200861200 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01063222A | IN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients | |
| Major Hospital | Past | Accepting new patients | |
| Major Hospital | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389657600000",
"number": "1013032325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 426",
"city": "NEW CASTLE",
"state": "IN",
"postal_code": "473620426",
"telephone_number": "765-521-0901",
"fax_number": "765-521-9891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 N 16TH ST",
"address_2": "SUITE G-10",
"city": "NEW CASTLE",
"state": "IN",
"postal_code": "473624319",
"telephone_number": "765-521-0901",
"fax_number": "765-521-9891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUM",
"first_name": "ANGELA",
"middle_name": "SUE FORNKOHL",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2014-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01063222A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000519955",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200861200",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Castle, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.