Derrick Lewis Blackwell, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2014-00430 Issued in NC

Practice address

4500 Cameron Valley Pkwy Ste 100
Charlotte, NC 28211-3542

Phone

(704) 384-7910

Fax

(704) 384-7914

NPI assigned

Apr 25, 2007

Last updated

Aug 1, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, OH2 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 2

Specialty

Family Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Weston Group IncGroup PAC ID 8123936796, shared by 8 NPIs, 215 clinicians

Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dblackwell32114@direct.novanthealth.org
• FHIR API: https://api.platform.athenahealth.com/14929/brand/3/csg/1/fhir/r4

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.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment Care Compare group NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  NPD
• The Cleveland Clinic Foundation

  • Family Medicine Physician
  • Avon, OH
  • NPI 1184428336
  NPD
• Piedmont East Urgent Care Center LLC

  dba Piedmont East Urgent Care

  • Urgent Care Clinic/Center
  • Rock Hill, SC
  • NPI 1437146537
  NPD (past)
• Piedmont Family Practice at Tega Cay, LLC

  dba Piedmont Family Practice at Tega Cay

  • Family Medicine Physician
  • Fort Mill, SC
  • NPI 1407863343
  NPD (past)
• Piedmont Physician Network LLC

  • Internal Medicine Physician
  • York, SC
  • NPI 1194277186

  Family Medicine

  NPD (past)
• Piedmont Urgent Care Center at Baxter Village LLC

  • Urgent Care Clinic/Center
  • Fort Mill, SC
  • NPI 1972590073
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1134348485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 CAMERON VALLEY PKWY STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113542",
            "telephone_number": "704-384-7910",
            "fax_number": "704-384-7914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3614 Providence Rd S",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Waxhaw",
            "state": "NC",
            "postal_code": "281736310",
            "country_code": "US",
            "telephone_number": "704-384-8640",
            "fax_number": "704-384-8650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "DERRICK",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101016178",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2014-00430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011221",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dblackwell32114@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "3614 Providence Rd S",
            "address_2": "Ste 200",
            "city": "Waxhaw",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281736310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kennedy Elizabeth Blackwelder
• Wesley E. Blackwelder, CRNA
• Anisa Blackwell
• Ashley Lynn Blackwell, CRNA
• Daniel B Blackwell
• James Blackwell, NP
• James Matthew Blackwell, MD
• Joseph Blackwell, MD
• Kameelah Corum Blackwell, COTA/L
• Katrina Linette Blackwell

• Family Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.