NPIMap

Individual provider Active NPI

Matthew Charles Blundell, MD

  • Internal Medicine Physician
  • Crescent City, CA
National Provider Identifier
1073511796
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A62659 Issued in CA
Practice address
1771 Northcrest Dr
Crescent City, CA 95531-8922
Phone
(707) 465-8666
Fax
(707) 465-8650
NPI assigned
Jul 7, 2005
Last updated
Sep 13, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A62659 CA Primary

Addresses

Primary practice location

1771 Northcrest Dr
Crescent City, CA 95531-8922

Mailing address

1771 Northcrest Dr
Crescent City, CA 95531-8922
Phone (707) 465-8666

Other identifiers 2

IdentifierTypeStateIssuer
00A626590MedicaidCA
103292OtherORNORIDIAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050412001161 CA Practitioner - Internal Medicine 7517864648 Reassigns benefits to 1 organization
Practice locations: Crescent City, CA
I20060214000163 OR Practitioner - Internal Medicine 7517864648 Practice locations: Brookings, OR

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1600 Weeot Way
Arcata, CA 95521-4734

1675 Northcrest Dr
Crescent City, CA 95531-8928
Phone (707) 464-2750

1771 Northcrest Dr
Crescent City, CA 95531-8922
Phone (707) 465-8666

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
62659CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Crescent City Internal Medicine Internal Medicine CurrentSince Jun 25, 1997 Accepting new patients
United Indian Health Services, Inc. CurrentSince Dec 22, 2025 Accepting new patients
Sutter Coast Hospital Current Accepting new patients
United Indian Health Services, Inc. CurrentSince Dec 22, 2025 Accepting new patients
United Indian Health Services, Inc. Past Accepting new patients

Locations

1600 Weeot Way
Arcata, CA 95521
Phone (707) 825-5000

1675 Northcrest Dr
Crescent City, CA 95531
Phone (707) 464-2750

1771 Northcrest Dr
Crescent City, CA 95531
Phone (707) 465-8666

800 E Washington Blvd
Crescent City, CA 95531
Phone (707) 464-8511

565 5th St
Ste 1
Brookings, OR 97415
Phone (541) 469-0969

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CABIAD
  • Direct secure messaging: matthew.blundell@ccim.eclinicaldirectplus.com
  • Direct secure messaging: mblundell166722@hisp.ehr.sutterhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1073511796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 NORTHCREST DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318922",
            "telephone_number": "707-465-8666",
            "fax_number": "707-465-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 NORTHCREST DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318922",
            "telephone_number": "707-465-8666",
            "fax_number": "707-465-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUNDELL",
        "first_name": "MATTHEW",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A62659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A626590",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN",
            "identifier": "103292",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, CA

Sources for this page

Verify at the official NPI Registry.