Bruce Alan Blackhart, M.D.
Individual provider Active NPI Family Medicine Physician · Oakdale, CA
NPI 1700874286 · NPPES record last updated Feb 4, 2015
Key facts
- NPI
- 1700874286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G65918 (CA)
- Practice address
- 1425 W H St
Ste 200
Oakdale, CA 95361-3588 - Phone
- (209) 848-1005
- Fax
- (209) 845-8918
- NPI assigned
- Oct 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070723000331 | CA | Practitioner - Family Practice | 9638270549 | Practice locations: Oakdale, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65918 | CA | MD | Pharmacist |
| G65918 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Valley Hospitals | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G65918 | CA | Yes |
Addresses
Primary practice location
1425 W H St
Ste 200
Oakdale, CA 95361-3588
Mailing address
1425 W H St
Ste 200
Oakdale, CA 95361-3588
Phone (209) 848-1005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G659180 | Medicaid | CA |
Other providers in Oakdale, CA
- Paul Robin Beatty
- Amulya C Belagavi
- Krystyna T Belski
- Hailey Benbow
- Paul Michael Bezas
- Scott Parker Blackhart
- Bordonas Oakdale Furniture TV and Appliance
- Jan Matthew Bosch
- Nicole Bowen
- Danielle Elise Christina Boyd
All providers in Oakdale, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.