Active NPI
Joseph Meran Blydenburgh Jr., P.A.
- Physician Assistant
- San Antonio, TX
National Provider Identifier
1730154881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01457
- Practice address
- 2961 Mossrock
San Antonio, TX 78230-5119 - Phone
- (210) 731-4800
- Fax
- (210) 731-4810
- NPI assigned
- Feb 22, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01457 | TX | Primary |
Addresses
Primary practice location
2961 Mossrock
San Antonio, TX 78230-5119
Mailing address
2961 Mossrock
San Antonio, TX 78230-5119
Phone (210) 731-4800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2961 Mossrock
San Antonio, TX 78230-5119
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01457 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538524800000",
"number": "1730154881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2961 MOSSROCK",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782305119",
"telephone_number": "210-731-4800",
"fax_number": "210-731-4810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2961 MOSSROCK",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782305119",
"telephone_number": "210-731-4800",
"fax_number": "210-731-4810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLYDENBURGH",
"first_name": "JOSEPH",
"middle_name": "MERAN",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2018-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA01457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.