Lawrence J Greenblatt X, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

791 Issued in WA

Practice address

1407 116TH Ave NE Ste 102
Bellevue, WA 98004-3819

Phone

(425) 637-0636

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2013 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Issaquah Obstetrics and Gynecology PLLC

  • Obstetrics & Gynecology Physician
  • Issaquah, WA
  • NPI 1073581807
  NPD (past)
• Overlake Medical Clinics LLC

  • Specialist
  • Bellevue, WA
  • NPI 1871745703
  NPD (past)
• Overlake Medical Clinics, LLC

  • Specialist
  • Bellevue, WA
  • NPI 1801828421
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265450514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 116TH AVE NE STE 102",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043819",
            "telephone_number": "425-637-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 116TH AVE NE STE 102",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043819",
            "telephone_number": "425-637-0636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBLATT",
        "first_name": "LAWRENCE",
        "middle_name": "J",
        "name_suffix": "X",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WA",
            "license": "791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Park Northwest Psychiatry LLC
• Deborah Lynn Green
• Emily Rose Green, M.A. MG61142666
• Heather Green, LMP
• Gregory S. Greenberg, PH.D.
• Ashley Elizabeth Greene, ND
• Horizon Greene, LICSW
• Isabella Jade Greene
• Shana Lane Greene
• Robert Bruce Greener, DDS

• Sports Medicine (Family Medicine) Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Sports Medicine (Family Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.