NPIMap

Individual provider Active NPI

Stephen Michael Blum, MD

  • Diagnostic Radiology Physician
  • Portland, OR
National Provider Identifier
1861441560
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0036077134 Issued in IL
Practice address
1001 NW Lovejoy St
Unit 706
Portland, OR 97209-3566
Phone
(503) 719-6544
Fax
(866) 898-2159
NPI assigned
May 9, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 036077134 IL
Diagnostic Radiology Physician 2085R0202X 0036077134 IL Primary

Addresses

Primary practice location

1001 NW Lovejoy St
Unit 706
Portland, OR 97209-3566

Mailing address

23625 Commerce Park
Suite 204
Beachwood, OH 44122
Phone (216) 255-5743

Other identifiers 11

IdentifierTypeStateIssuer
00598870MedicaidNY
402417601MedicaidMD
402417602MedicaidMD
8529588MedicaidWA
235428MedicaidAZ
P00922031OtherORRAILROAD MCR
036077134MedicaidIL
1861441560OtherTRICARE NORTH
2749477MedicaidOH
808256100MedicaidID
1451169MedicaidLA

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036077134ILMDNeuroradiology Physician
0036077134ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Global Medical Imaging, SC Diagnostic Radiology Past Accepting new patients
Med Tel International Corporation Past Accepting new patients
Med Tel International Corporation Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Post Oak Imaging LLC Past Accepting new patients
Med Tel International Corporation Past Accepting new patients
Radiological Physicians, LTD. Neuroradiology Past Accepting new patients
Med Tel International Corporation Past Accepting new patients
Preferred Imaging of Corinth, LLC Past Accepting new patients
Franklin & Seidelmann Inc Diagnostic Radiology Past Accepting new patients

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1861441560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23625 COMMERCE PARK",
            "address_2": "SUITE 204",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "44122",
            "telephone_number": "216-255-5743",
            "fax_number": "866-735-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 NW LOVEJOY ST",
            "address_2": "UNIT 706",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093566",
            "telephone_number": "503-719-6544",
            "fax_number": "866-898-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "STEPHEN",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "IL",
            "license": "036077134",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "0036077134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00598870",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402417601",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402417602",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8529588",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235428",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR",
            "identifier": "P00922031",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036077134",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE NORTH",
            "identifier": "1861441560",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2749477",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808256100",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1451169",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.