Active NPI
Casey Blackburn
- Specialist
- San Jose, CA
National Provider Identifier
1346648987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 111097739
- Practice address
- 2001 The Alameda
San Jose, CA 95126-1136 - Phone
- (408) 261-7777
- Fax
- (408) 259-2273
- NPI assigned
- Dec 14, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 111097739 | TN | Primary |
Addresses
Primary practice location
2001 The Alameda
San Jose, CA 95126-1136
Mailing address
614 N 11TH St
San Jose, CA 95112-3220
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111097739 | TN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418515200000",
"number": "1346648987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 N 11TH ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951123220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 THE ALAMEDA",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951261136",
"telephone_number": "408-261-7777",
"fax_number": "408-259-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "CASEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-14",
"last_updated": "2014-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TN",
"license": "111097739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.