Carol Lee Blackwood, MD
Individual provider Active NPI Family Medicine Physician · White River Junction, VT
NPI 1255301016 · NPPES record last updated Apr 22, 2011
Key facts
- NPI
- 1255301016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 042-0009782 (VT)
- Practice address
- 215 N Main St
Veterans Affairs Medical Center
White River Junction, VT 05009-0001 - Phone
- (802) 742-0415
- NPI assigned
- Jan 25, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- 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 |
|---|---|---|---|---|
| I20100512000231 | VT | Practitioner - Family Practice |
7719015759 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005-00643 | NC | MD | Family Medicine Physician |
| 042-0009782 | VT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Medical Care Systems Inc | Current |
Accepting new patients | |
| Springfield Medical Care Systems Inc. | Family Medicine | Current |
Accepting new patients |
Locations
1 Hospital Ct
Bellows Falls, VT 05101
Phone (802) 463-1292
38 Vt Route 11
Londonderry, VT 05148
1 Elm St
Ludlow, VT 05149
Phone (802) 228-8867
Interoperability endpoints
- https://api.platform.athenahealth.com/21546/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 042-0009782 | VT | Yes |
| Family Medicine Physician | 207Q00000X | 2005-00643 | NC |
Addresses
Primary practice location
215 N Main St
Veterans Affairs Medical Center
White River Junction, VT 05009-0001
Mailing address
215 N Main St
Veterans Affairs Medical Center
White River Junction, VT 05009-0001
Phone (802) 742-0415
Other providers in White River Junction, VT
- Stephen Bettwieser
- Peter Joseph Bill
- Edward R Billings
- Nancy B Birge
- Laura Bitterman
- Eric Barnes Bland
- Alicia Blazer
- Brooke Blicher
- Jill I Blumberg
- Sarah F Bohnson
All providers in White River Junction, VT · Family Medicine Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2011. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.