NPIMap

Individual provider Active NPI

Michael J Greenblatt, MD

  • Internal Medicine Physician
  • St Augustine, FL
National Provider Identifier
1619066099
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME180517 Issued in FL
Practice address
8595 Saint Johns Pkwy Ste B103
St Augustine, FL 32092-2064
Phone
(904) 376-4940
Fax
(904) 376-4943
NPI assigned
Oct 12, 2006
Last updated
Aug 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME180517 FL Primary
Internal Medicine Physician 207R00000X 223603 NY

Addresses

Primary practice location

8595 Saint Johns Pkwy Ste B103
St Augustine, FL 32092-2064

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-2092

Other identifiers 1

IdentifierTypeStateIssuer
02248231MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709000481 NY Practitioner - Internal Medicine 1658359344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of Ny Upstate Medical University, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

6 Wellness Way
Latham, NY 12110-2156
Phone (518) 782-3700

711 Troy Schenectady Rd
Latham, NY 12110-2461

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PLLC Internal Medicine CurrentSince May 3, 2004 Accepting new patients
Baptist Primary Care Internal Medicine Past Accepting new patients

Locations

250 Delaware Ave
Delmar, NY 12054
Phone (518) 439-7838

6 Wellness Way
Ste 201
Latham, NY 12110
Phone (518) 782-3900

711 Troy Schenectady Rd
Ste 203
Latham, NY 12110
Phone (518) 782-3742

711 Troy Schenectady Rd
Ste 210
Latham, NY 12110

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1619066099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8595 SAINT JOHNS PKWY STE B103",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320922064",
            "telephone_number": "904-376-4940",
            "fax_number": "904-376-4943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBLATT",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME180517",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "223603",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02248231",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.