Active NPI
Janine A Blackman, M.D.
- Family Medicine Physician
- Santa Monica, CA
National Provider Identifier
1578601357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G158880
- Practice address
- 2811 Wilshire Boulevard, Ste 610
Santa Monica, CA 90403-4814 - Phone
- (310) 453-2335
- Fax
- (214) 393-4645
- NPI assigned
- Feb 2, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | D57494 | MD | |
| Family Medicine Physician | 207Q00000X | G158880 | CA | Primary |
Addresses
Primary practice location
2811 Wilshire Boulevard, Ste 610
Santa Monica, CA 90403-4814
Mailing address
2811 Wilshire Boulevard, Ste 610
Santa Monica, CA 90403-4814
Phone (310) 453-2335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 22, 2013 through Apr 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G158880 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- janine.blackman@523775437635588.direct.elationemr.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.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557878400000",
"number": "1578601357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2811 WILSHIRE BOULEVARD, STE 610",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904034814",
"telephone_number": "310-453-2335",
"fax_number": "214-393-4645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2811 WILSHIRE BOULEVARD, STE 610",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904034814",
"telephone_number": "310-453-2335",
"fax_number": "214-393-4645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMAN",
"first_name": "JANINE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-02",
"last_updated": "2019-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MD",
"license": "D57494",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G158880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.