Fred Blackwell, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

G15873 Issued in CA

Practice address

2100 Otis Dr
Alameda, CA 94501-5786

Phone

(510) 748-0940

Fax

(510) 748-0926

NPI assigned

Feb 27, 2007

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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.

• Medical Group at City Center, Inc.

  • Pediatric Orthopaedic Surgery Physician
  • Alameda, CA
  • NPI 1881716124
  NPD (past) Authorized official

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386771186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SHERMAN ST",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945012236",
            "telephone_number": "510-748-0940",
            "fax_number": "510-748-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 OTIS DR",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945015786",
            "telephone_number": "510-748-0940",
            "fax_number": "510-748-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "FRED",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "G15873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate Elizabeth Birnbaum
• Natalie Felice Bishop
• Kathryn R Black, LAC, MT-BC
• Branden Martin Blacker
• Bonnie Blackman, PHD MFT
• Cinda Ann Blanchard
• Katherinne Abigail Blanco
• Stephanie Blank, AMFT
• Julian Blecken
• Ernest Bloom, MD

• Sports Medicine (Orthopaedic Surgery) Physician in Alameda, CA
• Providers in Alameda, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.