Rustam Blatov, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4335 Issued in CA

Practice address

1600 Eureka Rd
Roseville, CA 95661-3027

Phone

(916) 784-4000

NPI assigned

Feb 7, 2013

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

El Dorado Anesthesia Medical GroupGroup PAC ID 2163314048, 15 clinicians

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshall Medical Center Hospital, Placerville, CA, CCN 050254

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• El Dorado Anesthesia Medical Group

  • Anesthesiology Physician
  • Placerville, CA
  • NPI 1356390983
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group NPD
• Northbay Neonatology Associates, Inc

  • Neonatal-Perinatal Medicine Physician
  • Vallejo, CA
  • NPI 1265513360

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Sutter Valley Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Modesto, CA
  • NPI 1346615150
  Medicare reassignment
• Sutter Valley Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1457593980
  Medicare reassignment
• Sutter Valley Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
  • NPI 1467825844
  Medicare reassignment
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment
• Sutter Valley Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Elk Grove, CA
  • NPI 1972877264
  Medicare reassignment
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Vallejo, CA
  • NPI 1336222397
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

• Marshall Medical Center

  • General Acute Care Hospital
  • Placerville, CA
  • NPI 1972503142
  Care Compare affiliation

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1134468390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 EUREKA RD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613027",
            "telephone_number": "916-784-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 EUREKA RD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613027",
            "telephone_number": "916-784-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLATOV",
        "first_name": "RUSTAM",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-07",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "4335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1600 Eureka Rd",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956613027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katie Elizabeth Blair, RN, CNM
• Sharon Lanna Blalock
• Natalia Blanco
• William Andrew Blankenbehler Jr., DC
• Arianna Blasi
• Jacqueline Monet Blazek
• Marcia Blecher, PA
• Brady Bleicher, M.D.
• Nicholas Christopher Block, RN
• Danielle Michelle Blonstein, NURSE PRACTITIONER

• Certified Registered Nurse Anesthetist in Roseville, CA
• Providers in Roseville, CA by specialty
• Certified Registered Nurse Anesthetist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.