Bruce Alan Blackhart, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G65918 Issued in 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

Last updated

Feb 4, 2015By 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

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Sutter Valley Hospitals

  dba Memorial Medical Center

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1699129601
  NPD (past)

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423008000000",
    "number": "1700874286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 W H ST",
            "address_2": "STE 200",
            "city": "OAKDALE",
            "state": "CA",
            "postal_code": "953613588",
            "telephone_number": "209-848-1005",
            "fax_number": "209-845-8918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 W H ST",
            "address_2": "STE 200",
            "city": "OAKDALE",
            "state": "CA",
            "postal_code": "953613588",
            "telephone_number": "209-848-1005",
            "fax_number": "209-845-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKHART",
        "first_name": "BRUCE",
        "middle_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2015-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G65918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Robin Beatty, MD
• Amulya C Belagavi, MD
• Krystyna T Belski, M.D.
• Hailey Benbow
• Paul Michael Bezas, PA-C
• Scott Parker Blackhart, D.M.D.
• Bordonas Oakdale Furniture TV and Appliance
• Jan Matthew Bosch, BSN, RN, MSN, FNP
• Nicole Bowen
• Danielle Elise Christina Boyd, OD

• Family Medicine Physician in Oakdale, CA
• Providers in Oakdale, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.