Active NPI
Jody Blanco, M.D.
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
- New York, NY
National Provider Identifier
1780603191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
- License
- 152716-1
- Practice address
- 161 Fort Washington Ave
New York, NY 10032-3729 - Phone
- (212) 305-1107
- NPI assigned
- Jul 18, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 152716-1 | NY | |
| Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | 207VF0040X | 152716-1 | NY | Primary |
Addresses
Primary practice location
161 Fort Washington Ave
New York, NY 10032-3729
Mailing address
622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-4098
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 152716-1 | NY | MD | Female Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of Columbia University in the City of New York | Past | Accepting new patients | |
| Trustees of Columbia University in the Department of Otolaryngology | Past | Accepting new patients | |
| Trustees of Columbia University Dept of Obstetrics and GYN Ultrasound | Past | Accepting new patients |
Interoperability endpoints
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Organizations & group practices 3
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.
-
- Specialist
- New York, NY
- NPI 1366467243
-
- Surgery Physician
- New York, NY
- NPI 1508266347
-
- Specialist
- New York, NY
- NPI 1801074315
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381795200000",
"number": "1780603191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323720",
"telephone_number": "212-305-4098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 FORT WASHINGTON AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323729",
"telephone_number": "212-305-1107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO",
"first_name": "JODY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2013-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NY",
"license": "152716-1",
"primary": false
},
{
"code": "207VF0040X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
"state": "NY",
"license": "152716-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; 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.