NPIMap

Individual provider Active NPI

Jeffrey Ian Blume, MD

  • Family Medicine Physician
  • Lubbock, TX
National Provider Identifier
1871023945
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
S7012 Issued in TX
Practice address
9812 Slide Rd
Lubbock, TX 79424-5781
Phone
(806) 725-9940
Fax
(806) 723-6302
NPI assigned
Jun 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BP10059593 TX
Family Medicine Physician 207Q00000X S7012 TX Primary

Addresses

Primary practice location

9812 Slide Rd
Lubbock, TX 79424-5781

Mailing address

2215 Nashville Ave
Lubbock, TX 79410-1105
Phone (806) 725-5844

Other identifiers 3

IdentifierTypeStateIssuer
1F4320OtherTXMEDICARE
8NB459OtherTXBCBS
414081601MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200806003635 TX Practitioner - Family Practice 0042580987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

9812 Slide Rd
Lubbock, TX 79424-5781
Phone (806) 725-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
S7012TXMDFamily Medicine Physician
BP10059593TXMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Covenant Medical Group Family Medicine CurrentSince Sep 1, 2020 Accepting new patients

Locations

2215 Nashville Ave
Lubbock, TX 79410
Phone (806) 725-5228

9812 Slide Rd
Lubbock, TX 79424
Phone (806) 725-1000

Organizations & group practices 2

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1871023945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9812 SLIDE RD",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794245781",
            "telephone_number": "806-725-9940",
            "fax_number": "806-723-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUME",
        "first_name": "JEFFREY",
        "middle_name": "IAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-12",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10059593",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "S7012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1F4320",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8NB459",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "414081601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.