Active NPI
Michael Blackwell, PA
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1396351607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-10614
- Practice address
- 501 Billingsley Rd
Ste B
Charlotte, NC 28211-1009 - Phone
- (704) 444-2400
- NPI assigned
- Sep 22, 2020
- Last updated
- Sep 27, 2021
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-10614 | NC | Primary |
Addresses
Primary practice location
501 Billingsley Rd
Ste B
Charlotte, NC 28211-1009
Mailing address
PO Box 19305
Charlotte, NC 28219-9305
Other practice location 1
16740 Davidson Concord Rd
Davidson, NC 28036-8746
Phone (704) 444-2400
Other practice location 2
706 W King St
Kings Mountain, NC 28086-2708
Phone (980) 487-5470
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Ambulatory@direct.carolinashealthcare.org | Atrium Health |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-10614 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1396351607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19305",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282199305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 BILLINGSLEY RD",
"address_2": "STE B",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282111009",
"telephone_number": "704-444-2400"
}
],
"practiceLocations": [
{
"address_1": "16740 Davidson Concord Rd",
"address_purpose": "LOCATION",
"city": "Davidson",
"state": "NC",
"postal_code": "280368746",
"country_code": "US",
"telephone_number": "704-444-2400",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "706 W King St",
"address_purpose": "LOCATION",
"city": "Kings Mountain",
"state": "NC",
"postal_code": "280862708",
"country_code": "US",
"telephone_number": "980-487-5470",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACKWELL",
"first_name": "MICHAEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-22",
"last_updated": "2021-09-27",
"certification_date": "2021-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-10614",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Ambulatory@direct.carolinashealthcare.org",
"affiliation": "Y",
"affiliationName": "Atrium Health",
"address_1": "501 Billingsley Rd",
"address_2": "Ste B",
"city": "Charlotte",
"state": "NC",
"country_code": "US",
"postal_code": "282111009",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.