Mildred A Blandamer, FAMILY PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

34370 Issued in OK

Practice address

Brightside Health Telepsychiatry
2261 Market Street, Suite 10222
San Francisco, CA 94114

Phone

(918) 762-6604

Fax

(918) 762-6646

NPI assigned

Jun 21, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other names 1

• Ms. Mildred (Midge) A Blandamer Other name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brightside Medical of Michigan PCGroup PAC ID 9830562776, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Brightside Medical of Michigan PC

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1144800350

  OK

  Medicare reassignment Care Compare group NPD
• Pawnee IHS Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Pawnee, OK
  • NPI 1124178017
  NPD (past)

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1932420239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8108 E NORMAN ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740147414",
            "telephone_number": "918-316-9353",
            "fax_number": "918-517-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BRIGHTSIDE HEALTH TELEPSYCHIATRY",
            "address_2": "2261 MARKET STREET, SUITE 10222",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94114",
            "telephone_number": "918-762-6604",
            "fax_number": "918-762-6646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANDAMER",
        "first_name": "MILDRED",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "FAMILY PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-21",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "5400",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OK",
            "license": "34370",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AL",
            "license": "34334",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "4405",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MT",
            "license": "154915",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MILDRED (MIDGE)",
            "last_name": "BLANDAMER",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "APRN, CRNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Earl Jordan Blanche, D.M.D.
• Amie Marie Blanco, M.S.
• Karen Blanco
• Ruby S Blanco, RN
• Salma Adriana Blanco
• Russell Blando, LMFT
• Katherine Jennifer Blank, LCSW
• Sascha Blank, NBC-HWC
• Christina S Blankenburg, MS, CNS
• Rebecca Leanne Blankenburg, MD

• Psychiatric/Mental Health Nurse Practitioner in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.