Russell R Blakeley, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

16299 Issued in TN

Practice address

606 N Third Ave
Suite 203
Sandpoint, ID 83864-1594

Phone

(208) 263-8505

Fax

(208) 263-2908

NPI assigned

Sep 29, 2005

Last updated

Jan 27, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• East Tennessee Heart Consultants, P.C.

  • Cardiovascular Disease Physician
  • Knoxville, TN
  • NPI 1740583541
  NPD (past)

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453852800000",
    "number": "1063409639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-652-5250",
            "fax_number": "208-625-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 N THIRD AVE",
            "address_2": "SUITE 203",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641594",
            "telephone_number": "208-263-8505",
            "fax_number": "208-263-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKELEY",
        "first_name": "RUSSELL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2016-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "16299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3859386",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawna Elisa Benner-Erickson, MPT
• Tara Bennion
• Sharon L Bistodeau, RN
• James Michael Bittinger, PT
• Maresa Black, MOT, OTR/L
• Robert Edward Blomquist, PT, DPT
• Blue Iris Physical Therapy
• BNG Health Services, LLC.
• Aarow Bond Ellis
• Timothy Ray Bonine, MD

• Cardiovascular Disease Physician in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Cardiovascular Disease Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.