Active NPI
Gerardo Blanco Chacon, MD
- Student in an Organized Health Care Education/Training Program
- Macon, GA
National Provider Identifier
1134923949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 17597
- Practice address
- 380 Hospital Dr
Macon, GA 31217-8001 - Phone
- (478) 751-0514
- NPI assigned
- Apr 2, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 17597 | GA | Primary |
Addresses
Primary practice location
380 Hospital Dr
Macon, GA 31217-8001
Mailing address
672 Martin Luther King Jr Blvd Apt 3
Macon, GA 31201-3283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260506003219 | GA | Order and Referring Only - Internal Medicine | 2567930613 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17597 | GA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748563200000",
"number": "1134923949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "672 MARTIN LUTHER KING JR BLVD APT 3",
"city": "MACON",
"state": "GA",
"postal_code": "312013283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 HOSPITAL DR",
"city": "MACON",
"state": "GA",
"postal_code": "312178001",
"telephone_number": "478-751-0514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO CHACON",
"first_name": "GERARDO",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-04-02",
"last_updated": "2025-05-30",
"certification_date": "2025-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "GA",
"license": "17597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; 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.