Kendall Leon Blackwell, DPM
Individual provider Active NPI Primary Podiatric Medicine Podiatrist · Wilson, NC
NPI 1366483638 · NPPES record last updated Aug 9, 2022
Key facts
- NPI
- 1366483638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Podiatric Medicine Podiatrist 213EP1101X
- License
- 238 (NC)
- Practice address
- 1704 Glendale Dr SW
Suite a
Wilson, NC 27893-4678 - Phone
- (252) 237-0138
- Fax
- (252) 237-7903
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Instride Foot and Ankle Specialists, PLLC
Practice addresses (Care Compare)
1704 Glendale Dr SW
Suite a
Wilson, NC 27893-4679
Phone (252) 237-0138
Hospital & facility affiliations
- Wilson Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 60 |
| Removal or shaving of skin growth | 20 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110114000872 | NC | Practitioner - Podiatry | 9133318553 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238 | NC | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Instride Foot and Ankle Specialists, PLLC | Primary Podiatric Medicine | Current |
Accepting new patients |
| Instride Foot and Ankle Specialists, PLLC | Primary Podiatric Medicine | Current |
Accepting new patients |
| Piedmont Foot Clinic, PA | Primary Podiatric Medicine | Past | Accepting new patients |
Locations
103 Parkway Office Ct
Ste 100
Cary, NC 27518
Phone (919) 481-3338
1036 Branchview Dr
Ste 216
Concord, NC 28025
Phone (704) 886-1918
130 Lake Concord Rd NE
Ste B
Concord, NC 28025
Phone (704) 786-4482
1022 Lee Ann Dr NE
Concord, NC 28025
Phone (704) 786-4482
1704 Glendale Dr SW
Ste A
Wilson, NC 27893
Phone (252) 237-0138
Interoperability endpoints
- kendall.blackwell@ifasp.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 238 | NC | |
| Foot Surgery Podiatrist | 213ES0131X | 238 | NC | |
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 238 | NC | Yes |
Addresses
Primary practice location
1704 Glendale Dr SW
Suite a
Wilson, NC 27893-4678
Mailing address
1704 Glendale Dr SW
Wilson, NC 27893-4678
Phone (252) 237-0138
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79-0804G | Medicaid | NC |
Other providers in Wilson, NC
- Amanda Ellis Biermann
- Sarah Elizabeth Kirby Bischoff
- Kristen M Bissette
- Malisha Bissette
- Clarisa Renee Blackwell
- Jennifer Blake
- Ashley Johnson Blalock
- Deborah Blalock
- Nikolas Bland
- Blooming Beginnings PLLC
All providers in Wilson, NC · Primary Podiatric Medicine Podiatrist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.