Michael Bendele Blackmon, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

01081457A Issued in IN

Practice address

6124 W Parker Rd
Suite 530
Plano, TX 75093-8122

Phone

(214) 778-1075

Fax

(214) 778-1237

NPI assigned

Aug 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 5

Medicare fee-for-service enrollment

Enrolled in TX, IN, TN3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Pulmonary DiseaseAlso: Critical Care (Intensivists)

Education

University of Texas Medical Branch at Galveston, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

West Tennessee Healthcare Hospitalists IncGroup PAC ID 1951735521, 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
• Direct secure messaging: mblackmon378153@direct.casso.us.com
• Direct secure messaging: mblackmon196629@direct.parkviewexchange.com
• Direct secure messaging: michaelblackmon@arh.medalliesdirect.net

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.

• Parkview Health System Inc

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment Care Compare group NPD
• West Tennessee Healthcare Hospitalists Inc

  • Hospitalist Physician
  • Jackson, TN
  • NPI 1720635188
  Medicare reassignment Care Compare group
• C H Wilkinson Physician Network

  • Family Medicine Physician
  • Irving, TX
  • NPI 1457382947

  Critical Care Medicine

  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• C H Wilkinson Physician Network

  • Orthopaedic Surgery Physician
  • Corpus Christi, TX
  • NPI 1750826095
  NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Parkview Health System, Inc.

  • Pulmonary Disease Physician
  • Fort Wayne, IN
  • NPI 1548571227

  Critical Care Medicine

  NPD
• St Francis Medical Center, Inc

  • Rehabilitation Hospital Unit
  • Monroe, LA
  • NPI 1013906239
  NPD (past)

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

• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Parkview Hospital, Inc.

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1043202849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6124 W PARKER RD",
            "address_2": "SUITE 530",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938122",
            "telephone_number": "214-778-1075",
            "fax_number": "214-778-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6124 W PARKER RD",
            "address_2": "SUITE 530",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938122",
            "telephone_number": "214-778-1075",
            "fax_number": "214-778-1237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11104 Parkview Circle Dr Ste 410",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468450025",
            "country_code": "US",
            "telephone_number": "260-266-5260",
            "fax_number": "260-266-5279",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712017407",
            "country_code": "US",
            "telephone_number": "318-966-4541",
            "fax_number": "318-966-4543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "MICHAEL",
        "middle_name": "BENDELE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "LA",
            "license": "311912",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TX",
            "license": "K0266",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "K0266",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IN",
            "license": "01081457A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "311912",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 410",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468450025",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mblackmon196629@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 410",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468450025",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "309 Jackson St",
            "city": "Monroe",
            "state": "LA",
            "country_code": "US",
            "postal_code": "712017407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11104 Parkview Circle Dr Ste 410",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468450025",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mblackmon378153@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mblackmon378153@direct.casso.us.com",
            "address_1": "309 Jackson St",
            "city": "Monroe",
            "state": "LA",
            "country_code": "US",
            "postal_code": "712017407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Black Walnut Operations, LLC
• Black Willow Operations, LLC
• Sean Blackburn, LPC
• Helen Louise Blacklock, OTR
• Brittany Blackman, FNP-BC
• Blackshield Labs LLC
• Jaslyn Blackwell, RN
• Mariah Blackwell
• Alexandra Danielle Blaeser, P.A-C
• Alahna Blair

• Pulmonary Disease Physician in Plano, TX
• Providers in Plano, TX by specialty
• Pulmonary Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; 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.