David Blackmon, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0004360 Issued in FL

Practice address

330 A1A N Ste 325
Ponte Vedra Beach, FL 32082-1826

Phone

(904) 333-3389

Fax

(904) 713-2989

NPI assigned

Aug 28, 2006

Last updated

Oct 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• David C Blackmon,PHD,Psych SVC

  • Clinical Neuropsychologist
  • Jacksonville Beach, FL
  • NPI 1538438270
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381363200000",
    "number": "1144338211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 A1A N STE 325",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821826",
            "telephone_number": "904-333-3389",
            "fax_number": "904-713-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 A1A N STE 325",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821826",
            "telephone_number": "904-333-3389",
            "fax_number": "904-713-2989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "DAVID",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2013-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0004360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Joi Scheer Berger, MPT
• Roxana Bermeo-Lucas, OTR
• Joanna Yeakel Berry, MS SLP
• Barbara Dulaney Bishop, ED D LMHC
• Meaghan Bizon
• Blankenship Dental at Oakleaf PA
• Merralee Block, LMHC
• Sean Block
• Bombora Therapy, LLC
• Luke Maxwell Bote'

• Clinical Psychologist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; 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.