Blue and Green Medical PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD059706L Issued in PA

Legal business name

BLUE AND GREEN MEDICAL PC

Practice address

1743 Goucher Street
Johnstown, PA 15905

Phone

(814) 255-0102

Fax

(814) 255-0100

NPI assigned

May 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Nelly G Tepper, MDNPI 1134125412

Title

Owner

Phone

(814) 255-0102

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nelly Giselly Tepper, MD

  • Internal Medicine Physician
  • Johnstown, PA
  • NPI 1134125412
  NPD Authorized official

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821206178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159070819",
            "telephone_number": "814-255-0102",
            "fax_number": "814-255-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1743 GOUCHER STREET",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15905",
            "telephone_number": "814-255-0102",
            "fax_number": "814-255-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE AND GREEN MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TEPPER",
        "authorized_official_first_name": "NELLY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-255-0102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD059706L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015959820012",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK GROUP",
            "identifier": "1553821",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK INDIVIDUAL",
            "identifier": "883775",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Rosalene Bloom, BSW
• Bethany Lynne Blososky
• Alisha Mae Blough, BSN
• Michael Shawn Blough, BS
• Colin B Blount, M.A.
• Lauren Ann Blue, CRNP
• James E Boatman, M.D.
• Shaunna Marie Bobak
• Sai Harsha Bobba, MD
• Apryle Lynn Bober, CRNP

• Internal Medicine Physician in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.