Active NPI
James L Blackwell, DO
- Family Medicine Physician
- Scott Depot, WV
National Provider Identifier
1376711945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1090
- Practice address
- 3016 Great Teays Blvd
Scott Depot, WV 25560-9552 - Phone
- (304) 757-6999
- Fax
- (304) 757-3252
- NPI assigned
- Feb 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1090 | WV | Primary |
Addresses
Primary practice location
3016 Great Teays Blvd
Scott Depot, WV 25560-9552
Mailing address
301 Great Teays Blvd Ste 6
Scott Depot, WV 25560-9552
Phone (304) 757-6999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0041093000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1090 | WV | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Womencare, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Winfield, WV
- NPI 1760268643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284076800000",
"number": "1376711945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 GREAT TEAYS BLVD STE 6",
"city": "SCOTT DEPOT",
"state": "WV",
"postal_code": "255609552",
"telephone_number": "304-757-6999",
"fax_number": "304-757-3252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3016 GREAT TEAYS BLVD",
"city": "SCOTT DEPOT",
"state": "WV",
"postal_code": "255609552",
"telephone_number": "304-757-6999",
"fax_number": "304-757-3252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "JAMES",
"middle_name": "L",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-15",
"last_updated": "2010-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "1090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0041093000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scott Depot, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.