Individual provider Active NPI

Terra M Blint, PA

  • Medical Physician Assistant
  • Burr Ridge, IL
National Provider Identifier
1215923776
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
001380 Issued in IA
Practice address
901 McClintock Dr
Suite 202
Burr Ridge, IL 60527-0872
Phone
(888) 220-6432
Fax
(630) 654-4253
NPI assigned
Sep 21, 2005
Last updated
May 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 001380 IA Primary
Medical Physician Assistant 363AM0700X 085-001698 IL

Addresses

Primary practice location

901 McClintock Dr
Suite 202
Burr Ridge, IL 60527-0872

Mailing address

901 McClintock Dr
Suite 202
Burr Ridge, IL 60527-0872
Phone (888) 220-6432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 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

Enrollment IDStateProvider typePAC IDDetails
I20071105000223 IL Practitioner - Physician Assistant 8527155787 Reassigns benefits to 3 organizations
I20110216000511 IA Practitioner - Physician Assistant 8527155787 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trinity Medical CenterGroup PAC ID 2264337518, 97 clinicians

Practice addresses (Care Compare)

2701 17TH St
Rock Island, IL 61201-5351
Phone (309) 779-5000

4480 Utica Ridge Rd
Suite 160
Bettendorf, IA 52722-1637
Phone (563) 742-5950

4500 Utica Ridge Rd
Bettendorf, IA 52722-1626
Phone (563) 742-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001380IAMDMental Health Counselor
085-001698ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Metro Infectious Disease Consultants, LLC CurrentSince Jul 1, 2003 Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Jul 8, 2019 Accepting new patients
Trinity Medical Center CurrentSince Feb 1, 2021 Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Jul 8, 2019 Accepting new patients
Metro Infectious Disease Consultants LLC CurrentSince Jul 1, 2003 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

4500 Utica Ridge Rd
Bettendorf, IA 52722
Phone (563) 742-2724

125 E Zeller St
Ste D
North Liberty, IA 52317
Phone (319) 214-0005

400 Remington Blvd
Bolingbrook, IL 60440
Phone (630) 226-8100

901 McClintock Dr
Ste 202
Burr Ridge, IL 60527
Phone (630) 654-4201

600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342

1300 Franklin Ave
Ste 230C
Normal, IL 61761
Phone (309) 585-6029

2560 24th St
Ste 102
Rock Island, IL 61201
Phone (309) 779-3670

2701 17th St
Rock Island, IL 61201
Phone (309) 779-3200

Interoperability endpoints

  • Direct secure messaging: tblint97509@direct.unitypoint.org

Organizations & group practices 7

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1215923776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "888-220-6432",
            "fax_number": "630-654-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "888-220-6432",
            "fax_number": "630-654-4253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLINT",
        "first_name": "TERRA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "001380",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-001698",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

Verify at the official NPI Registry.