Michelle Blackston, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R160398 Issued in MD

Practice address

1105 N Point Blvd Ste 321
Baltimore, MD 21224-3472

Phone

(410) 517-7060

Fax

(443) 407-2942

NPI assigned

Oct 25, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michelle Pendora Johnson Former name

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holistic Health and Wellness LLCGroup PAC ID 3476941592, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Holistic Health and Wellness LLC

  • Multi-Specialty Clinic/Center
  • Baltimore, MD
  • NPI 1396355129
  Medicare reassignment Care Compare group NPD Authorized official
• Harcart Health Holdings, LLC

  • Emergency Medicine Physician
  • Rockville, MD
  • NPI 1912911215
  Medicare reassignment
• Holistic Health and Wellness LLC

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1063113132
  NPD (past) Authorized official
• Holistic Health and Wellness LLC

  • Addiction (Substance Use Disorder) Counselor
  • Baltimore, MD
  • NPI 1639850316
  NPD (past) Authorized official
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1457478703
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1649089418
  NPD
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Mount Airy, MD
  • NPI 1073963146
  NPD (past)

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1194277152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 N POINT BLVD STE 321",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243472",
            "telephone_number": "410-517-7060",
            "fax_number": "443-407-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 N POINT BLVD STE 321",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243472",
            "telephone_number": "410-517-7060",
            "fax_number": "443-407-2942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7000 Harford Rd",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212347704",
            "country_code": "US",
            "telephone_number": "443-438-5612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKSTON",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-25",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R160398",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R160398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "783304100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "JOHNSON",
            "middle_name": "PENDORA",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gabrielle Levine Blackman, M.D.
• Isabella Caroline Blackman
• Scott M Blackman, M.D., PH.D.
• Diane Blackmon, LCSW-C
• Blackstar Solutions LLC
• William Blackston, LCADC
• Yulanda Blackston, LGPC
• Marilyn Blackston. MD, MD
• Vernita Blackwell Amos, LCSW-C
• Donna Blackwell-Singleton, LPN

• Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.