Carol D Blacksher, APRN BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

099601 Issued in MO

Practice address

3535 S Jefferson Ave
Suite 118
Saint Louis, MO 63118-3930

Phone

(314) 776-7999

Fax

(314) 772-2257

NPI assigned

Aug 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Specialty

Certified Clinical Nurse Specialist (CNS)

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Clinical Research Associates PCGroup PAC ID 5597662080, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clinical Research Associates, PC

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1063632826
  Medicare reassignment Care Compare group
• Advanced Psychiatric Services

  • Psychiatry Physician
  • Sullivan, MO
  • NPI 1457303877
  NPD (past)
• Advanced Psychiatric Services Inc

  • Psychiatry Physician
  • Festus, MO
  • NPI 1154372464
  NPD (past)
• Chaganti and Associates PC

  • Psychiatry Physician
  • St Louis, MO
  • NPI 1366565103
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355788800000",
    "number": "1245249382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 THE HAMPTONS LANE",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175901",
            "telephone_number": "314-268-6195",
            "fax_number": "314-645-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 S JEFFERSON AVE",
            "address_2": "SUITE 118",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631183930",
            "telephone_number": "314-776-7999",
            "fax_number": "314-772-2257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSHER",
        "first_name": "CAROL",
        "middle_name": "D",
        "credential": "APRN BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2012-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "099601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427252515",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jannah D Blackmon
• Jessica Blackmon, OT
• Kailyn Blackmon, PSYD
• Taiyonna Marshea Lynnese Blackmon, LPN
• Blackmun Footcare LLC
• Blackwell & Roscoe Autism Spectrum Intervention Partners, Inc.
• Allison Blackwell
• Anita Jane Blackwell, RNCPNP
• Danielle Carmen Blackwell, ACNP
• Deborah A Blackwell, MSN, RN, FNP-C

• Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; 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.

Verify at the official NPI Registry.