Individual provider Active NPI

Thomas J Blastick, PA-C

  • Surgical Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1265458418
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10000823A Issued in IN
Practice address
8433 Harcourt Rd Ste 100
Indianapolis, IN 46260-2193
Phone
(317) 583-7600
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 10000823A IN Primary

Addresses

Primary practice location

8433 Harcourt Rd Ste 100
Indianapolis, IN 46260-2193

Mailing address

250 W 96TH St # 520
Indianapolis, IN 46260-1316

Other practice location 1

707 W 2nd St
Bloomington, IN 47403-2209
Phone (812) 334-5081

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10000823AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Major Hospital 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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1265458418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 96TH ST # 520",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8433 HARCOURT RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602193",
            "telephone_number": "317-583-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 W 2nd St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474032209",
            "country_code": "US",
            "telephone_number": "812-334-5081",
            "fax_number": "812-334-5091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLASTICK",
        "first_name": "THOMAS",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10000823A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.