NPIMap

Individual provider Active NPI

Mitchell Edward Blum, M.D.

  • Otolaryngology Physician
  • Tracy, CA
National Provider Identifier
1770586448
Registry record updated Apr 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
G25010 Issued in CA
Practice address
2160 W. Grantline Rd
Suite 250
Tracy, CA 95377
Phone
(209) 834-0626
Fax
(209) 834-1814
NPI assigned
May 24, 2005
Last updated
Apr 30, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X G25010 CA Primary
Facial Plastic Surgery Physician 207YS0123X G25010 CA

Addresses

Primary practice location

2160 W. Grantline Rd
Suite 250
Tracy, CA 95377

Mailing address

15 Oval Rd
Oakland, CA 94611
Phone (209) 834-0626

Other identifiers 1

IdentifierTypeStateIssuer
00G250100MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20061019000234 CA Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 8527064229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery
Education
Hahnemann University College of Medicine, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

2510 Airpark Dr
Suite 301
Redding, CA 96001-2462
Phone (530) 242-3500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G25010CAMDFacial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation Current Accepting new patients
Dignity Health Medical Foundation CurrentSince May 28, 2019 Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Mitchell E Blum MD Inc PastSince Aug 1, 2007 Accepting new patients
Thomas B McNemar MD Inc PastSince Aug 24, 2015 Accepting new patients
Doctors Hospital of Manteca, Inc. Past Accepting new patients

Locations

6501 Coyle Ave
Carmichael, CA 95608
Phone (916) 537-5000

2510 Airpark Dr
Ste 106
Redding, CA 96001
Phone (530) 241-9800

2510 Airpark Dr
Ste 301
Redding, CA 96001
Phone (530) 242-3500

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430352000000",
    "number": "1770586448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 OVAL RD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94611",
            "telephone_number": "209-834-0626",
            "fax_number": "510-817-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 W. GRANTLINE RD",
            "address_2": "SUITE 250",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "95377",
            "telephone_number": "209-834-0626",
            "fax_number": "209-834-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "MITCHELL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2015-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G25010",
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "CA",
            "license": "G25010",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G250100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

Verify at the official NPI Registry.