NPIMap

Individual provider Active NPI

Andrea Suzette Blackburn, M.D.

  • Family Medicine Physician
  • Lumberton, NC
National Provider Identifier
1235333675
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2007-01953 Issued in NC
Practice address
1003 Woodridge Dr
Lumberton, NC 28358-3328
Phone
(910) 250-5100
Fax
(910) 250-5111
NPI assigned
Jun 11, 2007
Last updated
Apr 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2007-01953 NC Primary

Addresses

Primary practice location

1003 Woodridge Dr
Lumberton, NC 28358-3328

Mailing address

1003 Woodridge Dr Ste B
Lumberton, NC 28358-3328
Phone (910) 250-5100

Other identifiers 2

IdentifierTypeStateIssuer
2022078BOtherNCMEDICARE
5909793MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080527000482 NC Practitioner - Family Practice 3072682426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Brody School of Medicine at East Carolina University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healing Hands Family Practice, PLLCGroup PAC ID 6901216308, 2 clinicians

Practice addresses (Care Compare)

1003 Woodridge Dr
Lumberton, NC 28358-3328
Phone (910) 250-5100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2007-01953NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Hands Family Practice PLLC Family Medicine CurrentSince Nov 2, 2020 Accepting new patients
Southeastern Regional Medical Clinic Past Accepting new patients
Robeson Family Practice Associates, P.a. Family Medicine PastSince Oct 1, 2013 Accepting new patients

Locations

1003 Woodridge Dr
Lumberton, NC 28358
Phone (910) 250-5100

1003 Woodridge Dr
Ste B
Lumberton, NC 28358

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJDCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJDCD/Endpoint/IGJDCD

Organizations & group practices 4

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1235333675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 WOODRIDGE DR STE B",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583328",
            "telephone_number": "910-250-5100",
            "fax_number": "910-251-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 WOODRIDGE DR",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583328",
            "telephone_number": "910-250-5100",
            "fax_number": "910-250-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "ANDREA",
        "middle_name": "SUZETTE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2007-01953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "2022078B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909793",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lumberton, NC

Sources for this page

Verify at the official NPI Registry.