Mark Blackmon, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5627 Issued in TN

Practice address

1301 Medical Center Dr
Nashville, TN 37232-0028

Phone

(615) 322-5000

NPI assigned

Jul 23, 2022

Last updated

Sep 3, 2026By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Middle Tennessee Emergency Physicians PC

  • Emergency Medicine Physician
  • Nashville, TN
  • NPI 1194758979
  Medicare reassignment
• Trevecca Nazarene University

  • Local Education Agency (LEA)
  • Nashville, TN
  • NPI 1033407952
  NPD (past)

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

{
    "created_epoch": "1658534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1184359051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691",
            "telephone_number": "615-322-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 MEDICAL CENTER DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372320028",
            "telephone_number": "615-322-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1559 Sparta St",
            "address_purpose": "LOCATION",
            "city": "McMinnville",
            "state": "TN",
            "postal_code": "371101316",
            "country_code": "US",
            "telephone_number": "931-815-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "MARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-23",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "5627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1301 Medical Center Dr",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372320028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taylor Black, DPT
• Theodore Black, MD
• Michele Nicole Blackledge, DDS
• Gwendolyn Lefran Blackman, MS, RD, LDN
• Talisa Blackman
• Zachary Bryant Blackmon, PHARMD
• Sandra Blackmore
• Blackshear Psychological Services, Inc.
• Tyra Blackshear-Mosley, RN
• Kristen Price Blackshear, PSY.D.

• Surgical Physician Assistant in Nashville, TN
• Providers in Nashville, TN by specialty
• Surgical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; 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.