Nicole Stacy Blacher, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 18069 Issued in CA

Practice address

11777 Sorrento Valley Rd
San Diego, CA 92121-1084

Phone

(858) 967-7701

NPI assigned

Feb 29, 2008

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

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1990

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.93 of 100Reported as group

Quality

68.7

Improvement activities

40

Cost

89.48

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Institute for Specialized Medicine,Inc

  • Medical Specialty Clinic/Center
  • San Diego, CA
  • NPI 1881870566
  NPD

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454630400000",
    "number": "1265602601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4653 CARMEL MOUNTAIN RD",
            "address_2": "STE 308-145",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306650",
            "telephone_number": "858-967-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11777 SORRENTO VALLEY RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211084",
            "telephone_number": "858-967-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACHER",
        "first_name": "NICOLE",
        "middle_name": "STACY",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-29",
        "last_updated": "2016-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 18069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tess Bjork-Kennedy
• Robert L Bjork, Jr. Jr., MD
• Rick Bjorklund, PSYD
• Mark Bjornson
• BL Anderson Medical Corporation
• Charlene Black, LMFT
• Chloe Alessandra Black
• Hilary Black, RN
• Jamie Z Black, PA-C
• Jennifer Black, MD, PHARMD

• Physical Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.