Ruperto Divino Blanco Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301076807 Issued in MI

Practice address

5838 Metro Way SW
Wyoming, MI 49519-9619

Phone

(616) 249-5300

Fax

(616) 249-5410

NPI assigned

May 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MI

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ruperto.blanco.1@15442.direct.athenahealth.com

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.

• Battle Creek Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Wyoming, MI
  • NPI 1881642858
  NPD

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1790736643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300",
            "fax_number": "616-249-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300",
            "fax_number": "616-249-5410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4038 Alpine Ave NW",
            "address_purpose": "LOCATION",
            "city": "Comstock Park",
            "state": "MI",
            "postal_code": "49321",
            "country_code": "US",
            "telephone_number": "616-827-2020",
            "fax_number": "616-827-2052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANCO",
        "first_name": "RUPERTO",
        "middle_name": "DIVINO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301076807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4619765",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4878220",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4619756",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4877705",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TYPE 1",
            "identifier": "0P441950001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Danielle Bivins, LMSW CAADC
• Anne Blackport, RN
• Matthew S Blair, DO
• Samantha Blair, PA-C
• Elizabeth Blanchette, LLP
• Isabel Anna Marie Blanks
• Sharell Shonteaja Blanks
• Kari Sue Blech, MSN, RN, FNP-BC
• Bluebird Afc Manor
• Kelsey Blystone, RN

• Family Medicine Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.