Individual provider Active NPI

John E Blanzy, DO

  • Family Medicine Physician
  • Southgate, MI
National Provider Identifier
1629017207
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101004825 Issued in MI
Practice address
14319 Dix-Toledo Rd
Southgate, MI 48195
Phone
(734) 285-0677
Fax
(734) 285-3574
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101004825 MI Primary

Addresses

Primary practice location

14319 Dix-Toledo Rd
Southgate, MI 48195

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Phone (947) 522-1863

Other identifiers 4

IdentifierTypeStateIssuer
111182991MedicaidMI
5820194OtherMIBCBSM
107352OtherCARE CHOICES
DR820558OtherM-CARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jblanzy110597@direct.beaumont.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100318000150 MI Practitioner - Family Practice 5991710410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1960
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

14319 Dix Toledo Rd
Southgate, MI 48195-2506
Phone (734) 285-0677

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

Hospital & facility affiliations

  • Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital - Taylor Hospital, Taylor, MI, CCN 230270
  • Corewell Health Trenton Hospital Hospital, Trenton, MI, CCN 230176

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101004825MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory, LLC CurrentSince Apr 1, 2012 Accepting new patients
Oakwood Ambulatory LLC Family Medicine CurrentSince Apr 1, 2012 Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

14319 Dix Toledo Rd
Southgate, MI 48195
Phone (734) 285-0677

Interoperability endpoints

  • Direct secure messaging: jblanzy110597@direct.beaumont.edu

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1629017207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1863",
            "fax_number": "947-522-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14319 DIX-TOLEDO RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "48195",
            "telephone_number": "734-285-0677",
            "fax_number": "734-285-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANZY",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101004825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111182991",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "5820194",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "107352",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE",
            "identifier": "DR820558",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jblanzy110597@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "14319 Dix-Toledo Rd",
            "city": "Southgate",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

Verify at the official NPI Registry.