Active NPI
Burton Blender, DO
- Family Medicine Physician
- Philadelphia, PA
National Provider Identifier
1366414005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS001927L
- Practice address
- 335 E Wyoming Ave
Philadelphia, PA 19120 - Phone
- (215) 455-0113
- Fax
- (215) 455-0853
- NPI assigned
- Feb 6, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS001927L | PA | Primary |
Addresses
Primary practice location
335 E Wyoming Ave
Philadelphia, PA 19120
Mailing address
101 East Olney Ave
505
Philadelphia, PA 19120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006567420005 | Medicaid | PA |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS001927L | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265328000000",
"number": "1366414005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 EAST OLNEY AVE",
"address_2": "505",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 E WYOMING AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19120",
"telephone_number": "215-455-0113",
"fax_number": "215-455-0853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLENDER",
"first_name": "BURTON",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-06",
"last_updated": "2010-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS001927L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "006567420005",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.