Active NPI
John Blackwell, APRN
- Psychiatric/Mental Health Nurse Practitioner
- Youngstown, OH
National Provider Identifier
1154870590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- APRN.CNP.025081
- Practice address
- 611 Belmont Ave
Youngstown, OH 44502-1037 - Phone
- (330) 744-2991
- NPI assigned
- Sep 27, 2016
- Last updated
- Jul 24, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | APRN.CNP.025081 | OH | Primary |
Addresses
Primary practice location
611 Belmont Ave
Youngstown, OH 44502-1037
Mailing address
3165 Clearwater St NW
Warren, OH 44485-2217
Phone (330) 974-7240
Other practice location 1
1344 5th Ave
Youngstown, OH 44504-1703
Phone (330) 472-2595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2488400 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Euclid Hospital Cleveland Clinic Health System | Current | Accepting new patients |
Interoperability endpoints
- jblackwell1377681@direct.ccf.org
Organizations & group practices 1
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.
-
dba cleveland clinic foundation
- General Acute Care Hospital
- Euclid, OH
- NPI 1457403016
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563926400000",
"number": "1154870590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3165 CLEARWATER ST NW",
"city": "WARREN",
"state": "OH",
"postal_code": "444852217",
"telephone_number": "330-974-7240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 BELMONT AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445021037",
"telephone_number": "330-744-2991"
}
],
"practiceLocations": [
{
"address_1": "1344 5th Ave",
"address_purpose": "LOCATION",
"city": "Youngstown",
"state": "OH",
"postal_code": "445041703",
"country_code": "US",
"telephone_number": "330-472-2595",
"fax_number": "330-742-2598",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACKWELL",
"first_name": "JOHN",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-27",
"last_updated": "2019-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OH",
"license": "APRN.CNP.025081",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2488400",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Youngstown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.