NPIMap

Individual provider Active NPI

Joseph Bruce Blackburn, MD

  • Family Medicine Physician
  • Medina, OH
National Provider Identifier
1730183138
Registry record updated Jan 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
350-77002-B Issued in OH
Practice address
1075 S Court St
Ste 100
Medina, OH 44256-3836
Phone
(330) 722-6337
Fax
(330) 722-0481
NPI assigned
Jun 13, 2005
Reactivated
Mar 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 350-77002-B OH Primary

Addresses

Primary practice location

1075 S Court St
Ste 100
Medina, OH 44256-3836

Mailing address

1075 S Court St
Ste 100
Medina, OH 44256-3836
Phone (330) 722-6337

Other identifiers 1

IdentifierTypeStateIssuer
2152281MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040211001004 OH Practitioner - Family Practice 8224922158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Buffalo School of Medicine, 1988
Medicare assignment
May accept Medicare assignment
Group practices
South Court Family Physicians IncGroup PAC ID 4183617863, 2 clinicians

Practice addresses (Care Compare)

1075 S Court St
Suite 100
Medina, OH 44256-3836
Phone (330) 722-6337

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
350-77002-BOHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Court Family Physicians Inc Family Medicine CurrentSince Sep 24, 2003 Accepting new patients
Medina Hospital Past Accepting new patients

Locations

1075 S Court St
Ste 100
Medina, OH 44256
Phone (330) 722-6337

Interoperability endpoints

  • Direct secure messaging: drjoeblackburn@scfp.medentdirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262822400000",
    "number": "1730183138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 S COURT ST",
            "address_2": "STE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442563836",
            "telephone_number": "330-722-6337",
            "fax_number": "330-722-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 S COURT ST",
            "address_2": "STE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442563836",
            "telephone_number": "330-722-6337",
            "fax_number": "330-722-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "JOSEPH",
        "middle_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2010-01-07",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "350-77002-B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2152281",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.