Active NPI
Samuel E Blackwell, PT
- Physical Therapist
- Redmond, OR
National Provider Identifier
1851433635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0908
- Practice address
- 735 SW 11TH St
Ste 103
Redmond, OR 97756-2649 - Phone
- (541) 923-1436
- Fax
- (541) 923-1467
- NPI assigned
- Feb 12, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0908 | OR | Primary |
Addresses
Primary practice location
735 SW 11TH St
Ste 103
Redmond, OR 97756-2649
Mailing address
735 SW 11TH St
Ste 103
Redmond, OR 97756-2649
Phone (541) 923-1436
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05-4082000 | Other | OR | BLUE CROSS BLUE SHIELD |
| 233502 | Medicaid | OR |
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 |
|---|---|---|---|
| 0908 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219017600000",
"number": "1851433635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "735 SW 11TH ST",
"address_2": "STE 103",
"city": "REDMOND",
"state": "OR",
"postal_code": "977562649",
"telephone_number": "541-923-1436",
"fax_number": "541-923-1467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "735 SW 11TH ST",
"address_2": "STE 103",
"city": "REDMOND",
"state": "OR",
"postal_code": "977562649",
"telephone_number": "541-923-1436",
"fax_number": "541-923-1467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "SAMUEL",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2008-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "0908",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "05-4082000",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "233502",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redmond, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.