Kimberly Suzzane Blackwell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10000609A Issued in IN

Practice address

8326 Naab Rd
Indianapolis, IN 46260-1920

Phone

(317) 871-0000

Fax

(317) 871-0010

NPI assigned

Oct 17, 2006

Last updated

Sep 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kimberly.blackwell.1@25782.direct.athenahealth.com
• Direct secure messaging: teamnursing@ihtc.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Indiana Hemophilia & Thrombosis Center, Inc.

  • Hematology & Oncology Physician
  • Indianapolis, IN
  • NPI 1659364800
  Medicare reassignment
• Innovative Hematology, Inc

  • Hematology & Oncology Physician
  • Indianapolis, IN
  • NPI 1881455541
  Medicare reassignment
• Emergency Physicians of Indianapolis, PC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1770538340
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1013098342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8326 NAAB RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601920",
            "telephone_number": "317-871-0000",
            "fax_number": "317-871-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8326 NAAB RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601920",
            "telephone_number": "317-871-0000",
            "fax_number": "317-871-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KIMBERLY",
        "middle_name": "SUZZANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000609A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "teamnursing@ihtc.org",
            "affiliation": "N",
            "address_1": "8326 Naab Rd",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462601920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lynda Lawrence Blackwelder, LMFT
• Brylee Christina Blackwell
• David Michael Blackwell II, MD
• Erika Blackwell
• James T Blackwell, MD
• Glenn A Blackwood, M.D.
• Mary E Blaha, DO
• James J Blahunka, MD
• Barbara P Blain, OTR
• Cherita R Blaine, COTA

• Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.