Jim D Blunk, DO
Individual provider Active NPI Family Medicine Physician · Caldwell, KS
NPI 1962402537 · NPPES record last updated Feb 8, 2018
Key facts
- NPI
- 1962402537
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 05-19457 (KS)
- Practice address
- 415 S Osage St
Caldwell, KS 67022-1650 - Phone
- (620) 845-2516
- Fax
- (620) 845-2518
- NPI assigned
- Jul 26, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050506000441 | KS | Practitioner - Family Practice | 1153387220 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05-19457 | KS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bass Memorial Baptist Hospital Dba Integris Bass Baptist Health Center | Past |
Accepting new patients | |
| Integris Bass Baptist Health Center | Past |
Accepting new patients | |
| Integris Bass Baptist Health Center | Past |
Accepting new patients | |
| Bass Memorial Baptist Hospital | Family Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2082 | OK | |
| Family Medicine Physician | 207Q00000X | 05-19457 | KS | Yes |
Addresses
Primary practice location
415 S Osage St
Caldwell, KS 67022-1650
Mailing address
5300 N Independence Ave
280
Oklahoma City, OK 73112-5556
Phone (620) 845-2516
Other practice location 1
415 S Osage St
Caldwell, KS 67022-1650
Phone (620) 845-2516
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100229560B | Medicaid | KS | |
| 100193490B | Medicaid | OK |
Other providers in Caldwell, KS
- Summer Grace Balman
- Karissa Bratcher
- Caldwell Compounding Pharmacy Inc
- Caldwell Pharmacy Inc
- Caldwell Pharmacy Inc
- Goodrick Home Care
All providers in Caldwell, KS · Family Medicine Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.