Individual provider Active NPI

Joshua Aaron Blackwell, MD, MSPH

  • Family Medicine Physician
  • Mount Shasta, CA
National Provider Identifier
1093334567
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A206348 Issued in CA
Practice address
912 Pine St
Mount Shasta, CA 96067-2143
Phone
(205) 603-8010
NPI assigned
Apr 14, 2020
Last updated
Jan 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14283-320 WI
Family Medicine Physician 207Q00000X 04-49978 KS
Family Medicine Physician 207Q00000X 52272 AL
Family Medicine Physician 207Q00000X MD-55925 IA
Family Medicine Physician 207Q00000X T7872 TX
Family Medicine Physician 207Q00000X A206348 CA Primary

Addresses

Primary practice location

912 Pine St
Mount Shasta, CA 96067-2143

Mailing address

3719 E Elmwood Dr
Wichita, KS 67218-4824
Phone (205) 603-8010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA, WI3 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

Enrollment IDStateProvider typePAC IDDetails
I20240109001955 TX Practitioner - Family Practice 6002267556 Reassigns benefits to 1 organization
I20260316000587 CA Practitioner - Family Practice 6002267556 Reassigns benefits to 1 organization
I20260518003634 WI Practitioner - Family Practice 6002267556 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity HealthGroup PAC ID 2062320559, 88 clinicians

Practice addresses (Care Compare)

914 Pine St
Mount Shasta, CA 96067-2143
Phone (530) 926-7131

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52272ALMDFamily Medicine Physician
A206348CAMDFamily Medicine Physician
MD-55925IAMDFamily Medicine Physician
04-49978KSMDFamily Medicine Physician
T7872TXMDFamily Medicine Physician
14283-320WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health CurrentSince Jan 23, 2026 Accepting new patients
Dignity Health CurrentSince Jan 23, 2026 Accepting new patients
Antioch Med Family Medicine CurrentSince Nov 10, 2024 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Dec 28, 2023 Accepting new patients

Locations

912 Pine St
Mount Shasta, CA 96067
Phone (530) 926-3653

914 Pine St
Mount Shasta, CA 96067
Phone (503) 926-6111

1126 S Clifton Ave
Wichita, KS 67218
Phone (316) 260-4000

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

215 Chisholm Trl
Jacksboro, TX 76458
Phone (940) 567-5528

1602 Avenue Q
Lubbock, TX 79401
Phone (469) 312-5137

Organizations & group practices 7

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 1

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": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1093334567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 E ELMWOOD DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672184824",
            "telephone_number": "205-603-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 PINE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672143",
            "telephone_number": "205-603-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "JOSHUA",
        "middle_name": "AARON",
        "credential": "MD, MSPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-14",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "14283-320",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-49978",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "52272",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "MD-55925",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T7872",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A206348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Shasta, CA

Sources for this page

Verify at the official NPI Registry.