NPIMap

Organization Active NPI

Blackwell Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Ellicott City, MD
National Provider Identifier
1053197343
Registry record updated Sep 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
BLACKWELL ANESTHESIA LLC
Practice address
6011 University Blvd Ste 190
Ellicott City, MD 21043-6104
Phone
(410) 461-0960
NPI assigned
Sep 4, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2023

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

Authorized official

Name
Poppy Walker, MBA
Title
Practice Administrator
Phone
(325) 675-6466

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

6011 University Blvd Ste 190
Ellicott City, MD 21043-6104

Mailing address

3301 S 14TH St Ste 16180
Abilene, TX 79605-5015
Phone (325) 675-6466

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230930000545 MD Part B Supplier - Clinic/Group Practice 9032563614 Receives reassigned benefits from 9 practitioners
Practice locations: Ellicott City, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1693785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693785600000",
    "number": "1053197343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 S 14TH ST STE 16180",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796055015",
            "telephone_number": "325-675-6466",
            "fax_number": "325-692-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6011 UNIVERSITY BLVD STE 190",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436104",
            "telephone_number": "410-461-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKWELL ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-04",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-04",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "POPPY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "325-675-6466",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.