Mark Blackwelder, M.D.
Individual provider Active NPI Internal Medicine Physician · Ruston, LA
NPI 1245200880 · NPPES record last updated Oct 15, 2009
Key facts
- NPI
- 1245200880
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 18456 (LA)
- Practice address
- 1200 S Farmerville St
Ruston, LA 71270-5941 - Phone
- (318) 255-3690
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- 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
- Green Clinic LLC
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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- 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 |
|---|---|---|---|---|
| I20100303001150 | LA | Practitioner - Internal Medicine | 0345320974 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- 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 | |
| Green Clinic LLC | Internal Medicine | Current |
Accepting new patients |
| CLHG-Ruston LLC | Current |
Accepting new patients | |
| CLHG-Ruston LLC | Current |
Accepting new patients |
Locations
1200 S Farmerville St
Ruston, LA 71270
Phone (318) 251-6103
411 E Vaughn Ave
Ste 104
Ruston, LA 71270
Phone (318) 254-2453
401 E Vaughn Ave
Ruston, LA 71270
Phone (318) 254-2100
Interoperability endpoints
- nlmmblack@yourcarecommunity.org
- mark.blackwelder.1@26990.direct.athenahealth.com
- mark.blackwelder@gcmc.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 18456 | LA | Yes |
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
Other providers in Ruston, LA
- Bio-Medical Applications of Louisiana, LLC
- Ashlynn Bishop
- Robert Marcus Black
- Aimee Blackham
- Cody Blackwelder
- Allie Blackwood
- Madeline Kate Blundell
- Boersma Clinic, LLC
- Taylor Blake Boggs
- Bonnie Lejeune Buller, LLC
All providers in Ruston, LA · Internal Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2009. 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.