Active NPI
Elizabeth Blotky, MD
- Pediatrics Physician
- Sherman Oaks, CA
National Provider Identifier
1447745807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A165305
- Practice address
- Pediatric Associates Medical Group
4330 Fulton Avenue
Sherman Oaks, CA 91423 - Phone
- (818) 784-1102
- NPI assigned
- Jun 28, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | A165305 | CA | Primary |
Addresses
Primary practice location
Pediatric Associates Medical Group
4330 Fulton Avenue
Sherman Oaks, CA 91423
Mailing address
1610 Silverwood Ter
Los Angeles, CA 90026-1448
Phone (310) 890-8975
Other practice location 1
4650 Sunset Blvd
Residency Office
Los Angeles, CA 90027
Phone (323) 361-2122
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A165305 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tenth Street Pediatric Medical Group, Inc. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- eblotky@tsp.pcc-direct.com
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.
-
- Pediatrics Physician
- Santa Monica, CA
- NPI 1548354129
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629244800000",
"number": "1447745807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 SILVERWOOD TER",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900261448",
"telephone_number": "310-890-8975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PEDIATRIC ASSOCIATES MEDICAL GROUP",
"address_2": "4330 FULTON AVENUE",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "91423",
"telephone_number": "818-784-1102"
}
],
"practiceLocations": [
{
"address_1": "4650 Sunset Blvd",
"address_2": "Residency Office",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "90027",
"country_code": "US",
"telephone_number": "323-361-2122",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLOTKY",
"first_name": "ELIZABETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-28",
"last_updated": "2021-08-18",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A165305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.