Individual provider Active NPI

Elizabeth Ann Blumenthal, MD

  • Obstetrics & Gynecology Physician
  • San Francisco, CA
National Provider Identifier
1164759916
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A107191 Issued in CA
Practice address
400 Parnassus Ave
San Francisco, CA 94143-2202
Phone
(415) 353-4624
Fax
(415) 353-2405
NPI assigned
Nov 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X A107191 CA
Obstetrics & Gynecology Physician 207V00000X A107191 CA Primary

Addresses

Primary practice location

400 Parnassus Ave
San Francisco, CA 94143-2202

Mailing address

400 Parnassus Ave
San Francisco, CA 94143-2202
Phone (415) 353-4624

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100723000599 CA Practitioner - Obstetrics/GynecologyPractitioner - Internal Medicine 9638201825 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A107191CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 5, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 5, 2019 Accepting new patients
Regents of the University of California Obstetrics & Gynecology CurrentSince Jul 21, 2017 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
University of California Irvine Current Accepting new patients
University of California Irvine CurrentSince Jul 21, 2017 Accepting new patients
UC Irvine Health Cancer Center, Newport Pacific Medical Center CurrentSince Jul 21, 2017 Accepting new patients
University of California Irvine Past Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

300 W Carl Karcher Way
Anaheim, CA 92801
Phone (657) 282-6356

441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

800 N Main St
Santa Ana, CA 92701
Phone (714) 456-6324

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1258070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1164759916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 PARNASSUS AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432202",
            "telephone_number": "415-353-4624",
            "fax_number": "415-353-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 PARNASSUS AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432202",
            "telephone_number": "415-353-4624",
            "fax_number": "415-353-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMENTHAL",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-13",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "A107191",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A107191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.