Melrose Ingle Blackett, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Memphis, TN
NPI 1376623819 · NPPES record last updated Apr 15, 2021
Key facts
- NPI
- 1376623819
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 0000015010 (TN)
- Practice address
- 6215 Humphreys Blvd Ste 300
Memphis, TN 38120-2382 - Phone
- (901) 757-0229
- Fax
- (901) 757-9503
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Washington University School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- West Tennessee Medical Group Inc
WT Medical Associates
Practice addresses (Care Compare)
1720 Woodlawn Ave
Dyersburg, TN 38024-1300
Phone (731) 421-6510
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.87 of 100
- Quality
- 64.75
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.81
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041122000648 | TN | Practitioner - Obstetrics/Gynecology |
0749244184 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000015010 | TN | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WT Medical Associates | Current |
Accepting new patients | |
| Baptist Memorial Medical Group Inc | Obstetrics & Gynecology | Current |
Accepting new patients |
| WT Medical Associates | Current |
Accepting new patients | |
| Baptist Memorial Medical Group Inc | Current |
Accepting new patients | |
| Dyersburg Health | Past | Accepting new patients | |
| Baptist Memorial Hospital | Past | Accepting new patients | |
| Baptist Memorial Hospital- Union City Inc | Past | Accepting new patients |
Locations
36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801
8138 Country Village Dr
Cordova, TN 38016
Phone (901) 725-8606
1720 Woodlawn Ave
Ste 1
Dyersburg, TN 38024
Phone (731) 285-2100
420 Wilkinson Dr
Fl 2
Dyersburg, TN 38024
Phone (731) 285-5133
400 E Tickle St
Dyersburg, TN 38024
Phone (731) 285-2410
7655 Poplar Ave
Ste 130
Germantown, TN 38138
Phone (901) 757-0229
8040 Wolf River Blvd
Ste 103
Memphis, TN 38138
Phone (901) 725-8606
6215 Humphreys Blvd
Ste 300
Memphis, TN 38120
Phone (901) 227-9870
6225 Humphreys Blvd
Memphis, TN 38120
Phone (901) 227-2727
965 Ridge Lake Blvd
Ste 103
Memphis, TN 38120
Phone (901) 227-3221
2100 Exeter Rd
Memphis, TN 38138
Phone (901) 757-1350
8970 Winchester Rd
Memphis, TN 38125
Phone (901) 794-5806
Interoperability endpoints
- mblackett30088@mlh.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 0000015010 | TN | Yes |
Addresses
Primary practice location
6215 Humphreys Blvd Ste 300
Memphis, TN 38120-2382
Mailing address
965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446
Other practice location 1
6225 Humphreys Blvd
Memphis, TN 38120-2373
Phone (901) 227-9103
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3726929 | Medicaid | TN |
Other providers in Memphis, TN
- Kendra Aisha Black
- Peyton Saraelizabeth Black
- Dexter Cornelius Blackburn
- Ryan Blackburn
- Tyler Ansley Blackburn
- Tomandra Blackman
- Cassandra Blackmon
- Celisa Rufus Blackmon
- Victoria Elise Blackmon
- Yolanda Ravon Blackmon
All providers in Memphis, TN · Obstetrics & Gynecology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2021. 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.