Active NPI
Bruce Gary Blank, DPM
- Podiatrist
- Martins Ferry, OH
National Provider Identifier
1790757490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 36002569
- Practice address
- 92 N 4TH St
Suite 27
Martins Ferry, OH 43935-1691 - Phone
- (740) 633-4188
- Fax
- (740) 633-4716
- NPI assigned
- Feb 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 36002569 | OH | Primary |
| Podiatrist | 213E00000X | 00239 | WV |
Addresses
Primary practice location
92 N 4TH St
Suite 27
Martins Ferry, OH 43935-1691
Mailing address
92 N 4TH St
Suite 27
Martins Ferry, OH 43935-1691
Phone (740) 633-4188
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6491296002 | Other | CIGNA | |
| 2102991 | Other | MAMSI | |
| 2569 | Other | OH | HEALTH PLAN |
| 480027937 | Other | RAILROAD MEDICARE | |
| 0099535000 | Medicaid | WV | |
| 0747213 | Medicaid | OH | |
| 000000141557 | Other | OH | ANTHEM BCBC |
| 01548623 | Medicaid | PA | |
| 4295099 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002569 | OH | MD | Podiatrist |
| 2569 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1790757490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "92 N 4TH ST",
"address_2": "SUITE 27",
"city": "MARTINS FERRY",
"state": "OH",
"postal_code": "439351691",
"telephone_number": "740-633-4188",
"fax_number": "740-633-4716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 N 4TH ST",
"address_2": "SUITE 27",
"city": "MARTINS FERRY",
"state": "OH",
"postal_code": "439351691",
"telephone_number": "740-633-4188",
"fax_number": "740-633-4716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANK",
"first_name": "BRUCE",
"middle_name": "GARY",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-06",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "OH",
"license": "36002569",
"primary": true
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "WV",
"license": "00239",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6491296002",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "2102991",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN",
"identifier": "2569",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480027937",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0099535000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0747213",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBC",
"identifier": "000000141557",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01548623",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4295099",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Martins Ferry, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.