Jerry Blacklock, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

G9066 Issued in TX

Practice address

6560 Fannin St
Suite 900
Houston, TX 77030-2761

Phone

(713) 441-3800

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jerry.blacklock.1@19643.direct.athenahealth.com
• Direct secure messaging: jblacklock30947@direct.houstonmethodist.org

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.

• TMH Physician Associates PLLC

  • Ophthalmology Physician
  • Houston, TX
  • NPI 1275779225
  Medicare reassignment NPD
• TMH Physician Associates PLLC

  • Orthopaedic Surgery Physician
  • Spring, TX
  • NPI 1043061351
  NPD

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485216000000",
    "number": "1124053392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6560 FANNIN ST",
            "address_2": "SUITE 900",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302761",
            "telephone_number": "713-441-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6560 FANNIN ST",
            "address_2": "SUITE 900",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302761",
            "telephone_number": "713-441-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKLOCK",
        "first_name": "JERRY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2017-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "G9066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8GD848",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00216844",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8EA863",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01331480",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8R9781",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Savannah Blackburn
• Spiros Lee Blackburn, M.D.
• Blackbyrd the Carrier Company
• Blackcar Medical
• Blackhawk Dental
• Jasmine Janay Blackman, MBA
• Brittany Blackmon Fenwick, PH.D.
• Ana Blackmon, M.D.
• Brandy Michelle Blackmon
• Eme Blackmon

• Neurological Surgery Physician in Houston, TX
• Providers in Houston, TX by specialty
• Neurological Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.