NPIMap

Organization Active NPI

Crescent City Internal Medicine

  • Internal Medicine Physician
  • Crescent City, CA
National Provider Identifier
1669468930
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CRESCENT CITY INTERNAL MEDICINE
Practice address
1771 Northcrest Dr
Crescent City, CA 95531-8922
Phone
(707) 465-8666
Fax
(707) 465-8650
NPI assigned
Sep 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Authorized official

Name
Dr. Matthew C Blundell, MDNPI 1073511796
Title
Physician
Phone
(707) 465-8666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1771 Northcrest Dr
Crescent City, CA 95531-8922

Mailing address

1771 Northcrest Dr
Crescent City, CA 95531-8922
Phone (707) 465-8666

Other identifiers 1

IdentifierTypeStateIssuer
GR0087830MedicaidCA

National Provider Directory

National Provider Directory

Locations

1771 Northcrest Dr
Crescent City, CA 95531
Phone (707) 465-8666

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CABIAD

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362009600000",
    "number": "1669468930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 NORTHCREST DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318922",
            "telephone_number": "707-465-8666",
            "fax_number": "707-465-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 NORTHCREST DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318922",
            "telephone_number": "707-465-8666",
            "fax_number": "707-465-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT CITY INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2013-02-28",
        "status": "A",
        "authorized_official_last_name": "BLUNDELL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "707-465-8666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0087830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.