Cory W Blocker, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

148700 Issued in MO

Practice address

1200 N One Mile Rd
Dexter, MO 63841-1000

Phone

(573) 624-7575

NPI assigned

Jul 24, 2007

Last updated

Oct 7, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Southeast Health Center of Stoddard County LLC

  dba Mercy Hospital Stoddard

  • Family Medicine Physician
  • Dexter, MO
  • NPI 1477997567
  NPD (past)

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444176000000",
    "number": "1396945663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011908",
            "telephone_number": "573-624-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411000",
            "telephone_number": "573-624-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOCKER",
        "first_name": "CORY",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2015-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "148700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI PEDIATRIC NURSE",
            "identifier": "148700",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Lou Ash, LPC
• Backworks Chiropractic and Wellness LLC
• Berthelot Counseling
• Betty Jo Berthelot, LPC
• John T Blair, MD
• Kristerpher Dean Brimberry, PMHNP
• Cynthia Rae Burlingame, LMFT
• Cambridge Adult Day Center-Dexter
• Dolly Ann Campbell, O.D
• Cape Home Oxygen, LLC (A Plus Medical Equipment)

• Pediatric Nurse Practitioner in Dexter, MO
• Providers in Dexter, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; 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.