Active NPI
Celeste Blanken, DO
- Family Medicine Physician
- Coos Bay, OR
National Provider Identifier
1083684773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO165427
- Practice address
- 1900 Woodland Dr
Coos Bay, OR 97420-2045 - Phone
- (541) 267-5151
- Fax
- (541) 266-4589
- NPI assigned
- Jan 25, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4868 | OH | |
| Family Medicine Physician | 207Q00000X | DO165427 | OR | Primary |
Addresses
Primary practice location
1900 Woodland Dr
Coos Bay, OR 97420-2045
Mailing address
1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone (541) 267-5151
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93-0635514 | Other | OR | GROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER |
| 1407812365 | Other | OR | GROUP NPI NORTH BEND MEDICAL CENTER |
| DO165427 | Other | OR | OREGON MEDICAL BOARD |
| R0000WFBTV | Other | OR | GROUP MEDICARE NORTH BEND MEDICAL CENTER |
| 16113 | Other | OR | GROUP MEDICAID NORTH BEND MEDICAL CENTER |
| 500671822 | Medicaid | OR |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4868 | OH | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404086400000",
"number": "1083684773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202045",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202045",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANKEN",
"first_name": "CELESTE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-25",
"last_updated": "2014-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "4868",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "DO165427",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER",
"identifier": "93-0635514",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP NPI NORTH BEND MEDICAL CENTER",
"identifier": "1407812365",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON MEDICAL BOARD",
"identifier": "DO165427",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE NORTH BEND MEDICAL CENTER",
"identifier": "R0000WFBTV",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICAID NORTH BEND MEDICAL CENTER",
"identifier": "16113",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500671822",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.