DR. FRED BLACKWELL (NPI# 1386771186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386771186 |
| Entity Type | Individual |
| Full Name | DR. FRED BLACKWELL |
| Credential | M.D. |
| Practice Address |
2100 Otis Dr Alameda CA 94501-5786 |
| Mailing Address |
1600 Sherman St Alameda CA 94501-2236 |
| Practice Telephone | 5107480940 |
| Practice Fax Number | 5107480926 |
| Mailing Telephone | 5107480940 |
| Mailing Fax Number | 5107480926 |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
G15873 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
2100 OTIS DR |
| City | ALAMEDA |
| State | CA |
| Zip Code | 94501-5786 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467452334 | Brett Thomas Rouleau | Dentist | 2100 Otis Dr, Suite D, Alameda, CA 94501-5786 | 2005-07-21 |
| 1710159926 | Richard A. Nolan, M.d., Inc. | Orthopaedic Surgery | 2100 Otis Dr, Suite B, Alameda, CA 94501-5780 | 2008-03-27 |
| 1881716124 | Medical Group At City Center, Inc. | Orthopaedic Surgery | 2100 Otis Dr, Alameda, CA 94501-5786 | 2007-04-06 |
| 1073588836 | Richard A Nolan | Orthopaedic Surgery | 2100 Otis Dr, Suite B, Alameda, CA 94501-5786 | 2006-02-22 |
| 1508866484 | David Keith Jalen | Dentist | 2100 Otis Dr, Suite D, Alameda, CA 94501-5786 | 2005-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386259158 | Hailee Ann Heiselbetz | Behavior Technician | 1025 Atlantic Ave. Ste 101, Alameda, CA 94501 | 2020-09-09 |
| 1134745961 | Linda Nykin | Naturopath | 2002 Monterey Cir, Alameda, CA 94501 | 2020-06-17 |
| 1801427570 | Mirna Rodriguez Lopez | Behavior Technician | 1025 Atlantic Ave. Ste. 101, Alameda, CA 94501 | 2020-01-30 |
| 1356987010 | Guadalupe H Hernandez | Technician | 3650 Mount Diablo Blvd, Layayette, CA 94501 | 2019-11-18 |
| 1952951832 | Lily T Nguyen | Behavior Technician | 1025 Atlantic Ave, Suite 101, Alameda, CA 94501 | 2019-09-12 |
| 1326503004 | Mary Macpherson | Speech-Language Pathologist | 2308 Central Ave., Alameda, CA 94501 | 2019-02-06 |
| 1285103838 | Stephanie Owens | Behavioral Analyst | 2213 Clinton Ave #a, Alameda, CA 94501 | 2018-11-13 |
| 1508349390 | Cindy Cabrera | Behavioral Analyst | 1025 Atlantic Ave Suite 101, Alameda, CA 94501 | 2018-09-08 |
| 1629554928 | Anita Elizabeth Bower | Behavioral Analyst | 125 Atlantic Ave Suite 101, Alameda, CA 94501 | 2018-07-19 |
| 1659862571 | Mariana Rocio Pacas Mexicano | Behavioral Analyst | 1025 Atlantic Ave. Suite 101, Alameda, CA 94501 | 2018-05-26 |
| Find all providers in zip 94501 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942513882 | James Guido Distefano Jr. | Orthopaedic Surgery | 947 Marina Village Pkwy, Alameda, CA 94501-1048 | 2010-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790341618 | Casey S Revenko | Orthopaedic Surgery | 2999 Regent St Ste 225, Berkeley, CA 94705-2117 | 2019-05-15 |
| 1225504301 | Amgad Alfred | Orthopaedic Surgery | 18145 Us Highway 18 Ste D, Apple Valley, CA 92307-2210 | 2018-10-16 |
| 1386136430 | Valley River Orthopedics and Sports Medicine | Orthopaedic Surgery | Valley River Orthopedics & Sports Medicine Inc, 3329 G St Ste A, Merced, CA 95340 | 2018-06-05 |
| 1073026696 | Optimal Physician Surgical Group | Orthopaedic Surgery | 25067 Jim Bridger Rd, Hidden Hills, CA 91302-1128 | 2017-11-06 |
| 1336669456 | Beach Cities Orthopedics Surgery Center, LLC | Orthopaedic Surgery | 400 S Sepulveda Blvd Ste 110, Manhattan Beach, CA 90266-6814 | 2017-06-20 |
| 1750818860 | Health Link Medical Group Inc | Orthopaedic Surgery | 899 Northgate Dr Ste 400, San Rafael, CA 94903-3667 | 2017-05-19 |
| 1962861476 | Mehta Orthopedics | Orthopaedic Surgery | 32145 Alvarado Niles Rd Ste 209, Union City, CA 94587-2930 | 2016-02-12 |
| 1649646282 | Bay Area Surgical Specialists, Inc. A Medical Corporation | Orthopaedic Surgery | 5924 Stoneridge Dr Ste 202, Pleasanton, CA 94588-5400 | 2015-08-18 |
| 1114346111 | Sean Robinson | Orthopaedic Surgery | 7551 Timberlake Way Ste 200, Sacramento, CA 95823-5422 | 2014-04-08 |
| 1851717938 | William R Campbell Do Prof Corp | Orthopaedic Surgery | 1 Daniel Burnham Ct Ste 365c, San Francisco, CA 94109-5490 | 2014-03-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.