Billy Jacob Blackmon, MD
Individual provider Active NPI Diagnostic Radiology Physician · Saint Simons Island, GA
NPI 1215058110 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1215058110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 001196 (GA)
- Practice address
- 154 Rosemont St
Saint Simons Island, GA 31522-1777 - Phone
- (912) 580-8162
- NPI assigned
- Apr 2, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 32
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Medical College of Georgia School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mori Bean and Brooks Inc
Prodocs LLC
Radiology Associates of South Carolina LLC
Practice addresses (Care Compare)
Saint Simons Island, GA 31522
Phone (904) 399-5550
Henderson, NV 89052
Phone (904) 399-5550
1740 Lions Club Rd
Madison, GA 30650-4762
Phone (800) 841-4236
2600 Laurel Rd E
Nokomis, FL 34275-3226
Phone (904) 399-5550
5990 Viscaya Grove St
Las Vegas, NV 89118-2883
Phone (469) 757-1042
Hospital & facility affiliations
- Sarasota Memorial Hospital
- Sacred Heart Hospital
- Sarasota Memorial Hospital - Venice
- Ascension Sacred Heart Bay
- Morgan Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.02 of 100
- Quality
- 75.26
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 78.14
Merit-based Incentive Payment System (MIPS)
- Final score
- 78.06 of 100
- Quality
- 72.79
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in GA, SC, FL, NV, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100831000519 | GA | Practitioner - Diagnostic Radiology | 4284758061 | Reassigns benefits to 6 organizations |
| I20150714000500 | SC | Practitioner - Diagnostic Radiology | 4284758061 | |
| I20200131001171 | FL | Practitioner - Diagnostic Radiology | 4284758061 | Reassigns benefits to 6 organizations |
| I20230504001835 | NV | Practitioner - Diagnostic Radiology | 4284758061 | Reassigns benefits to 4 organizations |
| I20250417001073 | NC | Practitioner - Diagnostic Radiology | 4284758061 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR.0058928 | CO | MD | Diagnostic Radiology Physician |
| 35.094883 | OH | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greensboro Radiology, PA | Diagnostic Radiology | Current |
Accepting new patients |
| Gastro Health LLC | Current |
Accepting new patients | |
| Wake Forest Health Network LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Tampa General Hospital | Current | Accepting new patients | |
| University Hospitals Medical Group Inc | Diagnostic Radiology | Current |
Accepting new patients |
| Florida Radiology Associates LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Wake Forest Health Network LLC | Current | Accepting new patients | |
| Florida Diagnostic Imaging Center Inc | Diagnostic Radiology | Current |
Accepting new patients |
| Medical Technology Transfer Corporation | Current | Accepting new patients | |
| Tower Imaging LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Tower Imaging LLC | Diagnostic Radiology | Current |
Accepting new patients |
| University of Cincinnati Physicians Company, LLC | Current |
Accepting new patients | |
| Morgan County Georgia Hospital Authority | Current | Accepting new patients | |
| Mori Bean and Brooks Inc | Diagnostic Radiology | Current |
Accepting new patients |
| North Brevard Medical Support, Inc | Current |
Accepting new patients | |
| Gastro Health, LLC | Current |
Accepting new patients | |
| Tower Imaging LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Medical Technology Transfer Corporation | Current |
Accepting new patients | |
| Prodocs LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Adventhealth West Florida Imaging, Inc. | Current |
Accepting new patients | |
| Sheridan Radiology Services of Pinellas, Inc. | Diagnostic Radiology | Current | Accepting new patients |
| Pinnacle Health Services of North Carolina LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Florida Diagnostic Imaging Center Inc | Diagnostic Radiology | Current |
Accepting new patients |
| Pinnacle Health Services of North Carolina, LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Wake Forest Health Network, LLC | Current |
Accepting new patients | |
| Radiology Consultants PC | Diagnostic Radiology | Past | Accepting new patients |
| Outpatient Imaging, LLC | Diagnostic Radiology | Past | Accepting new patients |
| Diagnostic Radiology & Imaging LLC | Diagnostic Radiology | Past | Accepting new patients |
| Golden Isles Vein Institute PC | Past | Accepting new patients |
Locations (25 of 32)
119 Oakfield Dr
Brandon, FL 33511
Phone (813) 571-5150
4675 Linton Blvd
Ste 202
Delray Beach, FL 33445
Phone (561) 495-5700
502 W Highland Blvd
Inverness, FL 34452
Phone (352) 344-6481
8375 Dix Ellis Trl
Ste 201
Jacksonville, FL 32256
Phone (904) 399-5810
700 W Oak St
Kissimmee, FL 34741
Phone (407) 518-3553
1800 W Hibiscus Blvd
Ste 100
Melbourne, FL 32901
Phone (321) 676-3535
3661 S Miami Ave
Ste 907
Miami, FL 33133
Phone (305) 856-7333
9408 SW 87th Ave
Ste 200
Miami, FL 33176
Phone 3054684190 ext. 5003
2600 Laurel Rd E
North Venice, FL 34275
Phone (941) 261-9000
2253 Heart Pine Ave
Odessa, FL 33556
Phone (813) 723-5911
7243 Della Dr
Orlando, FL 32819
Phone (407) 381-7366
2525 Martin Luther King Jr Blvd
Panama City, FL 32405
Phone (850) 873-6900
4511 N Davis Hwy
Ste 1B
Pensacola, FL 32503
Phone (850) 484-8454
390 Challenger Rd
Port Canaveral, FL 32920
Phone (321) 633-8640
1700 Tamiami Trl
Sarasota, FL 34239
Phone (941) 917-8507
1501 Pasadena Ave S
South Pasadena, FL 33707
Phone (727) 341-7777
6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411
6500 38th Ave N
St Petersburg, FL 33710
Phone (727) 341-4870
4719 N Habana Ave
Tampa, FL 33614
Phone (813) 874-9769
2106 S Lois Ave
Tampa, FL 33629
Phone (813) 287-1191
951 N Washington Ave
Titusville, FL 32796
Phone (302) 325-5511
250 Harrison St
Ste 100
Titusville, FL 32780
Phone (321) 268-6674
9330 State Road 54
Trinity, FL 34655
Phone (727) 834-4000
1740 Lions Club Rd
Madison, GA 30650
Phone (706) 342-1667
2000 Dan Proctor Dr
Saint Marys, GA 31558
Phone (912) 576-6160
Interoperability endpoints
- billyblackmon@mmc.medalliesdirect.net
- bblackmon175634@direct.tgh.org
- https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
- bblackmon2995919@carolinashealthcaresystem.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | DR.0058928 | CO | |
| Diagnostic Radiology Physician | 2085R0202X | 35.094883 | OH | |
| Diagnostic Radiology Physician | 2085R0202X | 001196 | GA | Yes |
Addresses
Primary practice location
154 Rosemont St
Saint Simons Island, GA 31522-1777
Mailing address
154 Rosemont St
Saint Simons Island, GA 31522-1777
Phone (912) 580-8162
Other practice location 1
234 Goodman St
Cincinnati, OH 45219-2364
Phone (513) 584-7355
Other providers in Saint Simons Island, GA
- Barbara Davanzo, M.D., P.C.
- Angela C Barnard
- Louis Anthony Barton
- Belinda Burroughs, Inc.
- Howard A Berg
- Edward Bolt
- Michele Diane Borst
- Diane Gwyn Bowen
- Nancy Hodges Bowen
- Robert W Bowen
All providers in Saint Simons Island, GA · Diagnostic Radiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.