Bruce Gragg Blackstone, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

MD00020762 Issued in WA

Practice address

625 9TH Ave
Suite 210
Longview, WA 98632-2465

Phone

(360) 501-3400

Fax

(360) 423-6862

NPI assigned

Feb 20, 2006

Last updated

Sep 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Longview Orthopedic Associates, PLLC

  • Orthopaedic Surgery Physician
  • Longview, WA
  • NPI 1003865072
  Authorized official Same address or phone
• Longview Orthopedic Associates-Astoria LLC

  • Orthopaedic Surgery Physician
  • Astoria, OR
  • NPI 1063737039
  Authorized official Same address or phone
• Longview Surgical Center LLC

  dba Pacific Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Longview, WA
  • NPI 1750481453
  NPD (past)

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1891760211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 9TH AVE",
            "address_2": "SUITE 210",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322465",
            "telephone_number": "360-501-3400",
            "fax_number": "360-423-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 9TH AVE",
            "address_2": "SUITE 210",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322465",
            "telephone_number": "360-501-3400",
            "fax_number": "360-423-6862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTONE",
        "first_name": "BRUCE",
        "middle_name": "GRAGG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD00020762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1131101",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195560",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ami Bitton
• Joshua Bitton, MSW, LICSWA, CAAR
• David Michael Black, MD
• Kathryn B Black, MD
• Rhonda Black, AA, AAC
• Molly Blanc
• Kyra Blanchard, BS, R-AAC
• Arianna Blanks
• Bonnie Bloesser
• Danyelle Bloomstrom, REGISTERED DIETITIAN

• Orthopaedic Surgery Physician in Longview, WA
• Providers in Longview, WA by specialty
• Orthopaedic Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.