Active NPI
Edward B Blair Jr., M.D.
- Internal Medicine Physician
- Alton, IL
National Provider Identifier
1093821605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036.060205
- Practice address
- 2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569 - Phone
- (618) 462-2222
- Fax
- (618) 463-5004
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036060205 | IL | |
| Internal Medicine Physician | 207R00000X | 036.060205 | IL | Primary |
Addresses
Primary practice location
2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569
Mailing address
2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569
Phone (618) 462-2222
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036060205 | Medicaid | IL | |
| 110191309 | Other | IL | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| 036.060205 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osf Healthcare System | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Osf Saint Anthony's Health Center
- Surgery Physician
- Alton, IL
- NPI 1437551322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390348800000",
"number": "1093821605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 SAINT ANTHONYS WAY",
"address_2": "SUITE 205",
"city": "ALTON",
"state": "IL",
"postal_code": "620024569",
"telephone_number": "618-462-2222",
"fax_number": "618-462-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 SAINT ANTHONYS WAY",
"address_2": "SUITE 205",
"city": "ALTON",
"state": "IL",
"postal_code": "620024569",
"telephone_number": "618-462-2222",
"fax_number": "618-463-5004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAIR",
"first_name": "EDWARD",
"middle_name": "B",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2014-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036060205",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036.060205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036060205",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110191309",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.