Douglas Blacklidge, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

070007898 Issued in IN

Practice address

2341 W Lincoln Rd
Kokomo, IN 46902-8012

Phone

(844) 424-3668

Fax

(317) 575-6909

NPI assigned

Oct 4, 2006

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Witham Memorial Hospital 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Witham Health Services Hospital, Lebanon, IN, CCN 150104
• Franciscan Health Lafayette Hospital, Lafayette, IN, CCN 150109
• Community Howard Regional Health Inc. Hospital, Kokomo, IN, CCN 150007

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (7 of 14)

Locations

Networks

• OH PPO
• KY PPO C-SNP
• devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
• KY PPO
• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
• IL HMO C-SNP
• IL PPO Downstate

Interoperability endpoints

• Direct secure messaging: douglas.blacklidgedpm.p33@direct.ahni.nextgenshare.com

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.

• Witham Memorial Hospital

  • Family Medicine Physician
  • Lebanon, IN
  • NPI 1083750293

  IN

  Medicare reassignment NPD
• American Health Network of Indiana LLC

  • Radiology Clinic/Center
  • New Albany, IN
  • NPI 1164304424
  NPD
• American Health Network of Indiana, LLC

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1831236272
  NPD
• Witham Memorial Hospital

  • Physical Therapist
  • Zionsville, IN
  • NPI 1952282204
  NPD
• American Health Network of Indiana, LLC

  • Family Medicine Physician
  • Mulberry, IN
  • NPI 1033220017
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• Podiatry Associates of Indiana PC

  • Foot & Ankle Surgery Podiatrist
  • Indianapolis, IN
  • NPI 1073606935

  Foot & Ankle Surgery

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Howard Regional Health, Inc

  • General Acute Care Hospital
  • Kokomo, IN
  • NPI 1902878994

  Hospital

  Care Compare affiliation
• Franciscan Health Lafayette

  • General Acute Care Hospital
  • Lafayette, IN
  • NPI 1356435341

  Hospital

  Care Compare affiliation
• Witham Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, IN
  • NPI 1699757401

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1003901133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2341 W LINCOLN RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469028012",
            "telephone_number": "844-424-3668",
            "fax_number": "317-575-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 W LINCOLN RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469028012",
            "telephone_number": "844-424-3668",
            "fax_number": "317-575-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKLIDGE",
        "first_name": "DOUGLAS",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "070007898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200058240",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "douglas.blacklidgedpm.p33@direct.ahni.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "2341 W Lincoln Rd",
            "city": "Kokomo",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469028012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rachel Lynn Bishir, LPN
• Bruce A. Blackburn, D.D.S.
• Colin James Blackburn, D.P.M
• Rebecca Ann Blackburn, RD
• Susan Lynn Blackburn, D.D.S.
• Amanda Marie Blackmon, DMD
• Kaiden Blane
• Aerial Blanton
• Bobby C Blanton
• Jacob Bledsoe, DO

• All providers in Kokomo, IN
• Foot & Ankle Surgery Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.