Scott Anthony Blackburn, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704326782 Issued in MI

Practice address

11275 Allen Rd
Southgate, MI 48195-3380

Phone

(313) 383-7071

Fax

(313) 383-7194

NPI assigned

May 25, 2022

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 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

94.54

Promoting interoperability

100

Improvement activities

40

Cost

82.19

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sblackburn374247@direct.hfhs.org

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.

• Downriver Heart and Vascular Specialists PC

  • Interventional Cardiology Physician
  • Southgate, MI
  • NPI 1194838383
  NPD
• Ghassan a Atto MD PLLC

  • Family Medicine Physician
  • Southgate, MI
  • NPI 1932457546
  NPD

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1003554494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11275 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481953380",
            "telephone_number": "313-383-7071",
            "fax_number": "313-383-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11275 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481953380",
            "telephone_number": "313-383-7071",
            "fax_number": "313-383-7194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "SCOTT",
        "middle_name": "ANTHONY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-25",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704326782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4704326782",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert H Bixler, DO
• Rania Bjaije
• Marian Bjerke, LLP
• Rebecca Black
• Vernetta Perrin Black, TLLP
• Brooke Blackmon
• Lakeisha M Blackwell, M.A.
• Blanzy Clinic
• Aaron J Blanzy, DO
• John E Blanzy, DO

• Primary Care Nurse Practitioner in Southgate, MI
• Providers in Southgate, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.