Active NPI
Sally S Blum, PA
- Medical Physician Assistant
- Mentor, OH
National Provider Identifier
1609818665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 50.004712RX
- Practice address
- 7060 Wayside Dr
Mentor, OH 44060-6527 - Phone
- (440) 357-2770
- NPI assigned
- Jun 12, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA051937 | PA | |
| Physician Assistant | 363A00000X | C0005860 | MD | |
| Medical Physician Assistant | 363AM0700X | 50.004712RX | OH | Primary |
Addresses
Primary practice location
7060 Wayside Dr
Mentor, OH 44060-6527
Mailing address
7060 Wayside Dr
Mentor, OH 44060-6527
Phone (440) 357-2770
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C0005860 | MD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinic Regional Physicians LLC | Past | Accepting new patients | |
| Warren General Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Beachwood, OH
- NPI 1043470453
-
- Family Medicine Physician
- Warren, PA
- NPI 1508803701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471392000000",
"number": "1609818665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7060 WAYSIDE DR",
"city": "MENTOR",
"state": "OH",
"postal_code": "440606527",
"telephone_number": "440-357-2770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7060 WAYSIDE DR",
"city": "MENTOR",
"state": "OH",
"postal_code": "440606527",
"telephone_number": "440-357-2770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUM",
"first_name": "SALLY",
"middle_name": "S",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-12",
"last_updated": "2016-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA051937",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C0005860",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OH",
"license": "50.004712RX",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.