Cassandra Blackwell, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA15883 Issued in CA

Practice address

18880 Cherry Valley Blvd.
Tuolumne, CA 95379

Phone

(209) 928-5400

Fax

(209) 928-5412

NPI assigned

Jun 15, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Sonora Community Hospital

  dba Forest Road Health & Wellness Center

  • Rural Health Clinic/Center
  • Sonora, CA
  • NPI 1003014952
  NPD
• Sonora Community Hospital

  • Community/Retail Pharmacy
  • Sonora, CA
  • NPI 1740582568
  NPD

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1265476964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18880 CHERRY VALLEY BLVD.",
            "city": "TUOLUMNE",
            "state": "CA",
            "postal_code": "95379",
            "telephone_number": "209-928-5400",
            "fax_number": "209-928-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18880 CHERRY VALLEY BLVD.",
            "city": "TUOLUMNE",
            "state": "CA",
            "postal_code": "95379",
            "telephone_number": "209-928-5400",
            "fax_number": "209-928-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "CASSANDRA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP71070F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA15883",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Altheide, PEER SPECIALIST
• Robert Dennis Boroff, M.D.
• Deborah Rachell Bryant, L.C.S.W.
• Cynthia Elaine Cassidy, RN
• Sara Croteau, CADC I
• Ephraim Alejandro Delgadillo Jr., CADC-I

• Physician Assistant in Tuolumne, CA
• Providers in Tuolumne, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.