Wyndal K Blankenship, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME77603 Issued in FL

Practice address

120 S John Sims Pkwy
Valparaiso, FL 32580-1212

Phone

(850) 678-6621

Fax

(850) 729-0331

NPI assigned

Aug 23, 2005

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20976/brand/1/csg/1/fhir/r4

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.

• Bridgeway Health Clinics, Inc.

  • General Practice Physician
  • Fort Walton Beach, FL
  • NPI 1366000432
  NPD

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1336132570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 S JOHN SIMS PKWY",
            "city": "VALPARAISO",
            "state": "FL",
            "postal_code": "325801212",
            "telephone_number": "850-678-6621",
            "fax_number": "850-729-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S JOHN SIMS PKWY",
            "city": "VALPARAISO",
            "state": "FL",
            "postal_code": "325801212",
            "telephone_number": "850-678-6621",
            "fax_number": "850-729-0331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENSHIP",
        "first_name": "WYNDAL",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME77603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC NUMBER",
            "identifier": "46862",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDI SENDER NUMBER",
            "identifier": "N1099",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256934500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annette Brabham OD PA
• Clarissa Ashford
• Brandie Jennell Bachman, MASSAGE THERAPIST
• Annette Brabham, O.D.
• Branscome Vision Group Inc
• Sharon Marie Branscome, O.D.
• Mary Catherine Brogdon, L.P.N
• C S Peters OD, PA

• Internal Medicine Physician in Valparaiso, FL
• Providers in Valparaiso, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.