Siara Southerland Blackburn

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-15739 Issued in NC

Practice address

3787 Shipyard Blvd
Wilmington, NC 28403-6148

Phone

(910) 332-3800

Fax

(910) 251-0421

NPI assigned

Dec 10, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Siara Nicole Southerland Former name

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergeortho PAGroup PAC ID 0749188894, 726 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Emergeortho PA

  • Orthopaedic Surgery Physician
  • Durham, NC
  • NPI 1376592964

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Emergeortho PA

  • Durable Medical Equipment & Medical Supplies
  • Eden, NC
  • NPI 1841170222
  NPD

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768694400000",
    "number": "1063228468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5105",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049155100",
            "telephone_number": "910-332-3800",
            "fax_number": "910-251-0421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3787 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036148",
            "telephone_number": "910-332-3800",
            "fax_number": "910-251-0421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "PO Box 563",
            "address_purpose": "LOCATION",
            "city": "Buies Creek",
            "state": "NC",
            "postal_code": "275060563",
            "country_code": "US",
            "telephone_number": "910-742-7823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "SIARA",
        "middle_name": "SOUTHERLAND",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-10",
        "last_updated": "2026-01-18",
        "certification_date": "2026-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIARA",
            "last_name": "SOUTHERLAND",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katelyn Carluzzo Black
• Kathryn F Black, PA
• Melissa Whitesell Black, CNM
• Charles T Blackburn, CRNA
• Linda Blackburn, RPH
• Thomas L Blackstone, MD
• Kimberly Nicole Blackwell, PA-C
• Shelby Layne Blackwell, FNP-C
• Caitlin Morgan Blades, MD
• Catherine Blair, NP-C

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2026; 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.