NPIMap

Organization Active NPI

Blossomwood Medical PC

Doing business as Blossomwood Medical

  • Internal Medicine Physician
  • Huntsville, AL
National Provider Identifier
1144451311
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD29689 Issued in AL
Legal business name
BLOSSOMWOOD MEDICAL PC
Doing business as
Blossomwood Medical
Practice address
2121 Whitesburg Dr SE
Suite C
Huntsville, AL 35801-4501
Phone
(256) 883-0107
Fax
(256) 883-0207
NPI assigned
Aug 5, 2009
Last updated
Feb 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

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

Authorized official

Name
Dr. Vytautas Pukis, MDNPI 1225270440
Title
Physician
Phone
(256) 431-9257

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD29689 AL Primary

Addresses

Primary practice location

2121 Whitesburg Dr SE
Suite C
Huntsville, AL 35801-4501

Mailing address

2121 Whitesburg Dr SE
Suite C
Huntsville, AL 35801-4501
Phone (256) 883-0107

Other identifiers 1

IdentifierTypeStateIssuer
113285MedicaidAL

Other names 1

  • Blossomwood Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090916000637 AL Part B Supplier - Clinic/Group Practice 4183770118 Receives reassigned benefits from 1 practitioner
Practice locations: Huntsville, AL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2022543Blossomwood Medical2121 Whitesburg Dr, Huntsville, AL 35801Certificate of waiverApr 4, 2027

National Provider Directory

National Provider Directory

Locations

1952 N Brindlee Mountain Pkwy
Arab, AL 35016
Phone (256) 200-1258

2121 Whitesburg Dr SE
Ste C
Huntsville, AL 35801
Phone (256) 883-0107

4950 Memorial Pkwy NW
Ste B
Huntsville, AL 35810
Phone (256) 759-9167

8416 Memorial Pkwy SW
Huntsville, AL 35802
Phone (256) 883-0107

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359936000000",
    "number": "1144451311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 WHITESBURG DR SE",
            "address_2": "SUITE C",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014501",
            "telephone_number": "256-883-0107",
            "fax_number": "256-883-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 WHITESBURG DR SE",
            "address_2": "SUITE C",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014501",
            "telephone_number": "256-883-0107",
            "fax_number": "256-883-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOMWOOD MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-05",
        "last_updated": "2013-02-04",
        "status": "A",
        "authorized_official_last_name": "PUKIS",
        "authorized_official_first_name": "VYTAUTAS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "256-431-9257",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "MD29689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113285",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossomwood Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; 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.