Stephanie Elizabeth Blackmore, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

245687 Issued in AZ

Practice address

14961 W Bell Rd Ste 100
Surprise, AZ 85374-3203

Phone

(623) 439-5176

Fax

(855) 583-1420

NPI assigned

Jul 31, 2020

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DIBADD

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.

• Healthful Healthcare PLLC

  • Primary Care Nurse Practitioner
  • Surprise, AZ
  • NPI 1811603202
  Medicare reassignment NPD Authorized official
• Maria Gonzalez Berlari, MD LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1699025981
  Medicare reassignment
• Craig M. Rundbaken, D.O. PLLC

  • Pulmonary Disease Physician
  • Sun City West, AZ
  • NPI 1821279308
  NPD (past)
• Sonoran Pulmonary and Critical Care PLLC

  • Pulmonary Disease Physician
  • Phoenix, AZ
  • NPI 1457651085
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Health

  • Emergency Care Clinic/Center
  • Litchfield Park, AZ
  • NPI 1265065445

  Hospital

  Care Compare affiliation
• Dignity Health

  • Emergency Care Clinic/Center
  • Glendale, AZ
  • NPI 1609408665

  Hospital

  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1982733655
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1992131734
  Care Compare affiliation

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

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1366052771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14961 W BELL RD STE 100",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853743203",
            "telephone_number": "623-439-5176",
            "fax_number": "623-304-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14961 W BELL RD STE 100",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853743203",
            "telephone_number": "623-439-5176",
            "fax_number": "855-583-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMORE",
        "first_name": "STEPHANIE",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-31",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "245687",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "245687",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Biren G. Patel, MD, PC
• Alexis Bischof, CNM
• Kimberly Black, LPN
• Trinity V Black
• Joseph Kay Blackburn
• Trahsean Blair
• Patricia Joan Blanck-Miller, NP
• Melissa Blevans, RN
• Paige Renae Blom, OD
• Blooming Rose Care Home LLC

• Family Nurse Practitioner in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.