Active NPI
Norma Lynn Blackwater, M.D.
- General Practice Physician
- Los Angeles, CA
National Provider Identifier
1457476038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- G83912
- Practice address
- 1125 W 6TH St
Suite 103
Los Angeles, CA 90017-1833 - Phone
- (213) 202-3970
- Fax
- (213) 975-9257
- NPI assigned
- Mar 20, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | G83912 | CA | Primary |
Addresses
Primary practice location
1125 W 6TH St
Suite 103
Los Angeles, CA 90017-1833
Mailing address
1125 W 6TH St
Suite 103
Los Angeles, CA 90017-1833
Phone (213) 202-3970
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G839120 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- General Practice
- Education
- University of North Dakota School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1453 W Temple St
Los Angeles, CA 90026-5648
Phone (213) 202-3970
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
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.
-
- Community Health Clinic/Center
- Los Angeles, CA
- NPI 1740335678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1457476038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 W 6TH ST",
"address_2": "SUITE 103",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171833",
"telephone_number": "213-202-3970",
"fax_number": "213-975-9257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 W 6TH ST",
"address_2": "SUITE 103",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171833",
"telephone_number": "213-202-3970",
"fax_number": "213-975-9257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWATER",
"first_name": "NORMA",
"middle_name": "LYNN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "G83912",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G839120",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.