Kimberly Suzzane Blackwell, PA-C
Individual provider Active NPI Physician Assistant · Indianapolis, IN
NPI 1013098342 · NPPES record last updated Sep 10, 2021
Key facts
- NPI
- 1013098342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10000609A (IN)
- Practice address
- 8326 Naab Rd
Indianapolis, IN 46260-1920 - Phone
- (317) 871-0000
- Fax
- (317) 871-0010
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050117000482 | IN | Practitioner - Physician Assistant | 5395794374 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10000609A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians of Indianapolis, PC | Past | Accepting new patients |
Interoperability endpoints
- kimberly.blackwell.1@25782.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10000609A | IN | Yes |
Addresses
Primary practice location
8326 Naab Rd
Indianapolis, IN 46260-1920
Mailing address
8326 Naab Rd
Indianapolis, IN 46260-1920
Phone (317) 871-0000
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | teamnursing@ihtc.org |
Other providers in Indianapolis, IN
- Lynda Lawrence Blackwelder
- Brylee Christina Blackwell
- David Michael Blackwell II
- Erika Blackwell
- James T Blackwell
- Glenn A Blackwood
- Mary E Blaha
- James J Blahunka
- Barbara P Blain
- Cherita R Blaine
All providers in Indianapolis, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2021. 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.