Brian Matthew Blank, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD52429 Issued in SC

Practice address

1068 N Church St Ste 101
Greenville, SC 29601-1769

Phone

(864) 702-2365

Fax

(864) 474-4109

NPI assigned

Apr 4, 2015

Last updated

Feb 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2022 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brian.blank@96274799263748.direct.elationemr.com

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.

• Ember Modern Medicine

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295465763

  Single Specialty

  NPD Authorized official
• Spartanburg Medical Center

  dba Medical Group of the Carolinas - Piedmont Women's Healthcare

  • Obstetrics & Gynecology Physician
  • Spartanburg, SC
  • NPI 1376580852

  Single Specialty

  NPD (past)
• Woodruff Road Urgent Care Center, P.C.

  dba AFC Urgent Care

  • Primary Care Clinic/Center
  • Powdersville, SC
  • NPI 1205475001
  NPD (past)

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

{
    "created_epoch": "1428105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1689069833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 N CHURCH ST STE 101",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296011769",
            "telephone_number": "864-702-2365",
            "fax_number": "864-474-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 N CHURCH ST STE 101",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296011769",
            "telephone_number": "864-702-2365",
            "fax_number": "864-474-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "BRIAN",
        "middle_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-04",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "MD52429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Khalil Blakley, COTA/L
• Natausha Blakley
• Joshua Douglas Blanchard, DO
• Jessica Blandin
• Blank Space Therapy
• Mary Brittain Blankenship, M.D.
• Harold Puryear Blanks III, MD
• Nathan Arthur Blanton, D.C.
• Elena Rhianon Blas, NP
• Joseph Vincent Valentino Blas, M.D.

• Family Medicine Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.