NPIMap

Organization Active NPI

Medical Group at City Center, Inc.

  • Pediatric Orthopaedic Surgery Physician
  • Alameda, CA
National Provider Identifier
1881716124
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
G15873 Issued in CA
Legal business name
MEDICAL GROUP AT CITY CENTER, INC.
Practice address
2100 Otis Dr
Alameda, CA 94501-5786
Phone
(510) 748-0940
NPI assigned
Apr 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Fred Blackwell, M.D.NPI 1386771186
Title
President
Phone
(510) 748-0940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XP3100X G15873 CA Primary

Addresses

Primary practice location

2100 Otis Dr
Alameda, CA 94501-5786

Mailing address

1600 Sherman St
Alameda, CA 94501-2236
Phone (510) 748-0940

National Provider Directory

National Provider Directory

Locations

1600 Sherman St
Alameda, CA 94501

2100 Otis Dr
Alameda, CA 94501
Phone (510) 748-0940

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881716124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SHERMAN ST",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945012236",
            "telephone_number": "510-748-0940",
            "fax_number": "510-748-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 OTIS DR",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945015786",
            "telephone_number": "510-748-0940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GROUP AT CITY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-748-0940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "CA",
            "license": "G15873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alameda, CA

Sources for this page

  • 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.