Physician Compare National (NPI:1730183138)

HEALTHCARE PROVIDER: JOSEPH BRUCE BLACKBURN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1730183138
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224922158
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040211001004
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLACKBURN
	Individual professional last name
Provider First Name	JOSEPH
	Individual professional first name
Provider Middle Name	BRUCE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1075 S COURT ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	MEDINA
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	442563836
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360091
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDINA HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360020
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SUMMA HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M