Marcus E Blackstone, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

18747 Issued in SC

Practice address

404 SE Main St
Simpsonville, SC 29681-2652

Phone

(864) 963-8002

Fax

(864) 963-2742

NPI assigned

Aug 11, 2006

Last updated

Jun 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• St Francis Physician Services Inc

  dba Bon Secours Covenant Primary Care

  • Internal Medicine Physician
  • Greenville, SC
  • NPI 1871895771
  Medicare reassignment NPD
• Stoneview Internal Medicine PA

  • Internal Medicine Physician
  • Simpsonville, SC
  • NPI 1790845675
  Authorized official Same address or phone
• St Francis Physician Services Inc

  dba Bon Secours Rheumatology

  • Rheumatology Physician
  • Greenville, SC
  • NPI 1093036121
  NPD
• Greenville Health System

  dba GHS Cardiovascular SVCS Simp

  • General Acute Care Hospital
  • Simpsonville, SC
  • NPI 1679992838
  NPD (past)
• St Francis Physician Services Inc

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295769438

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1366453458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "address_2": "404 SOUTHEAST MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "29681",
            "telephone_number": "864-963-8002",
            "fax_number": "864-963-2742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 SE MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296812652",
            "telephone_number": "864-963-8002",
            "fax_number": "864-963-2742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTONE",
        "first_name": "MARCUS",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "18747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "18747",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187470",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00446146",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "576007863095",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nivedita S Bijoor, MD
• Laurel Delaney Black, PT
• Sonja Rena Black, RN
• Daniel Blackmon
• Connie J Blackstone, MD
• Thomas Harold Blackwell, MD
• Thomas Matthew Blackwell, DMD
• Lindsay Blair
• Christina L Blake, NP
• Haley Elise Blake, FNP-BC

• Internal Medicine Physician in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.