Individual provider Active NPI

Heather Patterson Blackburn, NP-C

  • Nurse Practitioner
  • Pinehurst, NC
National Provider Identifier
1023684040
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5014482 Issued in NC
Practice address
205 Page Rd
Pinehurst, NC 28374-8798
Phone
(910) 295-5511
NPI assigned
Jun 1, 2021
Last updated
Jun 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5014482 NC Primary

Addresses

Primary practice location

205 Page Rd
Pinehurst, NC 28374-8798

Mailing address

1320 Old Glendon Rd
Carthage, NC 28327-9266
Phone (910) 639-4554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20210624000052 NC Practitioner - Nurse Practitioner 2860893153 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCPC-18, LLCGroup PAC ID 2668741208, 31 clinicians
Pinehurst Medical Clinic IncGroup PAC ID 5991617169, 162 clinicians

Practice addresses (Care Compare)

205 Page Rd
Pinehurst, NC 28374-8749
Phone (910) 295-9211

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5014482NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Medical Clinic, Inc. CurrentSince Jun 28, 2021 Accepting new patients
MCPC-18, LLC CurrentSince Aug 17, 2021 Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Jun 28, 2021 Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients

Locations

205 Page Rd
Pinehurst, NC 28374
Phone (910) 295-9211

110 Fields Dr
Ste 1
Sanford, NC 27330
Phone (919) 777-9005

Interoperability endpoints

  • Direct secure messaging: heatherblackburn@phmc.allscriptsdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1023684040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 OLD GLENDON RD",
            "city": "CARTHAGE",
            "state": "NC",
            "postal_code": "283279266",
            "telephone_number": "910-639-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PAGE RD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748798",
            "telephone_number": "910-295-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "HEATHER",
        "middle_name": "PATTERSON",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5014482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.