NPIMap

Individual provider Active NPI

Kellie Miranda Smith Blackwell, D.O.

  • Family Medicine Physician
  • Abingdon, VA
National Provider Identifier
1104053891
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102203141 Issued in VA
Practice address
117 Cook St
Abingdon, VA 24210-3203
Phone
(276) 619-5052
Fax
(276) 619-5115
NPI assigned
Jun 19, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5527 TN
Family Medicine Physician 207Q00000X 0102203141 VA Primary

Addresses

Primary practice location

117 Cook St
Abingdon, VA 24210-3203

Mailing address

PO Box 3889
Johnson City, TN 37602-3889
Phone (423) 433-6625

Other practice location 1

320 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 390-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120913000229 VA Practitioner - Family Practice 8820245749 Reassigns benefits to 1 organization
I20240122000818 TN Practitioner - Family Practice 8820245749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Virginia Campus, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Franklin Healthcare Associates, PLLCGroup PAC ID 2466346291, 258 clinicians

Practice addresses (Care Compare)

117 Cook St
Abingdon, VA 24210-3203
Phone (276) 619-5052

320 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 390-1900

Hospital & facility affiliations

  • Amedisys Home Health Care Home health agency, Abingdon, VA, CCN 497566
  • Adoration Home Health Home health agency, Wise, VA, CCN 497288
  • Russell County Hospital Hospital, Lebanon, VA, CCN 490002
  • Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
  • Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063
  • Smyth County Community Hospital Hospital, Marion, VA, CCN 490038

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
State of Franklin Healthcare Associates PLLC CurrentSince Jan 14, 2024 Accepting new patients
State of Franklin Healthcare Associates PLLC Family Medicine CurrentSince Feb 1, 2024 Accepting new patients

Locations

320 Steeles Rd
Bristol, TN 37620
Phone (423) 390-1900

313 Princeton Rd
Ste 3
Johnson City, TN 37601
Phone (423) 282-4819

117 Cook St
Abingdon, VA 24210
Phone (276) 619-5052

390 Kane St
Gate City, VA 24251
Phone (276) 386-3411

Interoperability endpoints

  • Direct secure messaging: kellieblackwell@sofha.allscriptsdirect.net
  • FHIR API: https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

Hospital & facility affiliations 11

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": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1104053891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3889",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376023889",
            "telephone_number": "423-433-6625",
            "fax_number": "423-723-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 COOK ST",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242103203",
            "telephone_number": "276-619-5052",
            "fax_number": "276-619-5115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Steeles Rd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376209532",
            "country_code": "US",
            "telephone_number": "423-390-1900",
            "fax_number": "423-390-1899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KELLIE",
        "middle_name": "MIRANDA SMITH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-19",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "5527",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102203141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Abingdon, VA

Sources for this page

Verify at the official NPI Registry.