Individual provider Active NPI

Rachel Blind, NP

  • Nurse Practitioner
  • Royal Oak, MI
National Provider Identifier
1407867799
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704228706 Issued in MI
Practice address
3535 W 13 Mile Rd
Suite 209
Royal Oak, MI 48073-6770
Phone
(248) 565-3996
Fax
(248) 655-8181
NPI assigned
Aug 11, 2006
Last updated
May 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704228706 MI Primary

Addresses

Primary practice location

3535 W 13 Mile Rd
Suite 209
Royal Oak, MI 48073-6770

Mailing address

3535 W 13 Mile Rd Ste 205
Royal Oak, MI 48073-6770
Phone (248) 551-8180

Other names 1

  • Rachel Dickerson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20051028000937 MI Practitioner - Nurse Practitioner 7517984545 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

4949 Coolidge Hwy
Royal Oak, MI 48073-1026
Phone (248) 655-3220

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704228706MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Royal Oak Surgical Associates PC CurrentSince Jul 11, 2012 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Oct 1, 2018 Accepting new patients

Locations

1695 12 Mile Rd
Ste 220
Berkley, MI 48072
Phone (248) 545-6100

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

468 Cadieux Rd
Grosse Pointe Woods, MI 48230
Phone (313) 343-1000

3535 W 13 Mile Rd
Ste 205
Royal Oak, MI 48073
Phone (248) 288-2188

3535 W 13 Mile Rd
Ste 209
Royal Oak, MI 48073
Phone (248) 288-1660

Interoperability endpoints

  • Direct secure messaging: rblind1225951@epic00.shdirect.org

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1407867799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD STE 205",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736770",
            "telephone_number": "248-551-8180",
            "fax_number": "248-551-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD",
            "address_2": "SUITE 209",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736770",
            "telephone_number": "248-565-3996",
            "fax_number": "248-655-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLIND",
        "first_name": "RACHEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704228706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHEL",
            "last_name": "DICKERSON",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.