Active NPI
Mark Blackwelder, M.D.
- Internal Medicine Physician
- Ruston, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 18456
- Practice address
- 1200 S Farmerville St
Ruston, LA 71270-5941 - Phone
- (318) 255-3690
- NPI assigned
- Jan 25, 2006
- Last updated
- Oct 15, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 18456 | LA | Primary |
Addresses
Primary practice location
1200 S Farmerville St
Ruston, LA 71270-5941
Mailing address
1200 S Farmerville St
Ruston, LA 71270-5941
Phone (318) 255-3690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Louisiana State University School of Medicine in Shreveport, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1200 S Farmerville St
Ruston, LA 71270-5941
Phone (318) 255-3690
Hospital & facility affiliations
- Magnolia Home Health Care, Inc
- Primestar Home Health of Nwla, Inc
- Lagniappe Homecare Northern Louisiana
- Best Home Health
- Allegiance Home Health of Northeast la
- Northern Louisiana Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.51 of 100
- Quality
- 60.04
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18456 | LA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Clinic LLC | Current | Accepting new patients | |
| CLHG-Ruston LLC | Current | Accepting new patients | |
| Green Clinic LLC | Internal Medicine | Current | Accepting new patients |
| CLHG-Ruston LLC | Current | Accepting new patients |
Locations
1200 S Farmerville St
Ruston, LA 71270
Phone (318) 251-6103
401 E Vaughn Ave
Ruston, LA 71270
Phone (318) 254-2100
411 E Vaughn Ave
Ste 104
Ruston, LA 71270
Phone (318) 254-2453
Interoperability endpoints
- mark.blackwelder.1@26990.direct.athenahealth.com
- mark.blackwelder@gcmc.directbygreenway.com
- nlmmblack@yourcarecommunity.org
Organizations & group practices 5
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.
-
dba Allegiance Medical Clinic Northside Family Practice
- Family Medicine Physician
- Ruston, LA
- NPI 1821819665
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Northern Louisiana Medical Center
- General Acute Care Hospital
- Ruston, LA
- NPI 1962024026
-
- Home Health Agency
- Winnfield, LA
- NPI 1609844596
-
- Home Health Agency
- Arcadia, LA
- NPI 1245348317
-
dba Allegiance Home Health of Northeast Louisiana
- Home Health Agency
- West Monroe, LA
- NPI 1437185055
-
- Home Health Agency
- Minden, LA
- NPI 1952350456
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255564800000",
"number": "1245200880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 S FARMERVILLE ST",
"city": "RUSTON",
"state": "LA",
"postal_code": "712705941",
"telephone_number": "318-255-3690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 S FARMERVILLE ST",
"city": "RUSTON",
"state": "LA",
"postal_code": "712705941",
"telephone_number": "318-255-3690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELDER",
"first_name": "MARK",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2009-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "LA",
"license": "18456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruston, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; 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.