Active NPI
Mark E Blankenburg, MD
- Pediatrics Physician
- Hamilton, OH
National Provider Identifier
1639159072
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Jan 19, 2012.
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 50381
- Practice address
- 25 North F Street
Hamilton, OH 45013 - Phone
- (513) 868-1011
- Fax
- (513) 868-6170
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 50381 | OH | Primary |
Addresses
Primary practice location
25 North F Street
Hamilton, OH 45013
Mailing address
25 North F Street
Hamilton, OH 45013
Phone (513) 868-1011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0558427 | Medicaid | OH |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50381 | OH | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639159072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 NORTH F STREET",
"city": "HAMILTON",
"state": "OH",
"postal_code": "45013",
"telephone_number": "513-868-1011",
"fax_number": "513-868-6170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 NORTH F STREET",
"city": "HAMILTON",
"state": "OH",
"postal_code": "45013",
"telephone_number": "513-868-1011",
"fax_number": "513-868-6170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANKENBURG",
"first_name": "MARK",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "50381",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0558427",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hamilton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.