Staci Blackwell, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

7282 Issued in NC

Practice address

125 Baldwin Ave Ste 100
Charlotte, NC 28204-3370

Phone

(704) 316-1900

Fax

(704) 384-5453

NPI assigned

Apr 24, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

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.

• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492

  NC

  Medicare reassignment Care Compare group NPD
• Novant Health Medical Group, LLC

  • Foot & Ankle Surgery Podiatrist
  • Thomasville, NC
  • NPI 1235715582
  Care Compare group
• Novant Health Medical Group, LLC

  • Foot Surgery Podiatrist
  • Clemmons, NC
  • NPI 1295110906
  Care Compare group
• Novant Health Medical Group, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1306950282
  Care Compare group
• Novant Health Medical Group, LLC

  • Foot Surgery Podiatrist
  • Kernersville, NC
  • NPI 1386029254
  Care Compare group
• Novant Health Medical Group, LLC

  • Primary Podiatric Medicine Podiatrist
  • Winston Salem, NC
  • NPI 1427398023
  Care Compare group
• Novant Health Medical Group, LLC

  • Neurological Surgery Physician
  • Winston Salem, NC
  • NPI 1497080006
  Care Compare group
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Wake Forest, NC
  • NPI 1659571768
  Care Compare group
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Salisbury, NC
  • NPI 1750534038
  Care Compare group
• Novant Health Medical Group, LLC

  • Foot Surgery Podiatrist
  • Winston Salem, NC
  • NPI 1851776728
  Care Compare group
• Novant Health Medical Group, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1891764320
  Care Compare group
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Indian Land, SC
  • NPI 1245335421
  Care Compare group

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1356516033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BALDWIN AVE STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043370",
            "telephone_number": "704-316-1900",
            "fax_number": "704-384-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "STACI",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NC",
            "license": "7282",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "NC",
            "license": "1166",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sblackwell47164@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "125 Baldwin Ave Ste 100",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kameelah Corum Blackwell, COTA/L
• Katrina Linette Blackwell
• Michael Blackwell, PA
• Richard Thomas Blackwell, PHD
• Shatoya Blackwell
• Terri Elizabeth Blackwell, MD
• Olive Bear Blackwood, LMFTA
• Bladder Behavior, PLLC
• Steve Blahitka, MA
• Ann Nicole Blaine-Coambs, DDS

• All providers in Charlotte, NC
• Audiologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; 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.