Active NPI
Felicia Marie Blackenberry
- Home Health Aide
- Groveport, OH
National Provider Identifier
1073081279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 3868 Eastrise Dr
Groveport, OH 43125-9046 - Phone
- (614) 920-0106
- NPI assigned
- Nov 6, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | OH | Primary |
Addresses
Primary practice location
3868 Eastrise Dr
Groveport, OH 43125-9046
Mailing address
3868 Eastrise Dr
Groveport, OH 43125-9046
Phone (614) 920-0106
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0257866 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541462400000",
"number": "1073081279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3868 EASTRISE DR",
"city": "GROVEPORT",
"state": "OH",
"postal_code": "431259046",
"telephone_number": "614-920-0106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3868 EASTRISE DR",
"city": "GROVEPORT",
"state": "OH",
"postal_code": "431259046",
"telephone_number": "614-920-0106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKENBERRY",
"first_name": "FELICIA",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-06",
"last_updated": "2018-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0257866",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Groveport, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.