NPIMap

Individual provider Active NPI

Tristan Dee Blackburn, M.D.

  • Rheumatology Physician
  • Louisville, KY
National Provider Identifier
1417176249
Registry record updated Jul 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
46118 Issued in KY
Practice address
3991 Dutchmans LN Ste 208
Louisville, KY 40207-4723
Phone
(502) 899-6061
Fax
(502) 899-6127
NPI assigned
Apr 24, 2007
Last updated
Jul 9, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 46118 KY Primary

Addresses

Primary practice location

3991 Dutchmans LN Ste 208
Louisville, KY 40207-4723

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Other identifiers 3

IdentifierTypeStateIssuer
7100252740MedicaidKY
201069110MedicaidIN
50052639OtherKYPASSPORT- NORTON RHEUMATOLOGY SPECIALISTS

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tblackburn62016@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130823000743 KY Practitioner - Rheumatology 7618131053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
University of Louisville School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

3991 Dutchmans LN
Louisville, KY 40207-4723

825 Barret Ave
Louisville, KY 40204-1743
Phone (502) 272-5165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46118KYMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Aug 1, 2013 Accepting new patients
Community Medical Associates, Inc. CurrentSince Aug 1, 2013 Accepting new patients
Norton Hospitals, Inc Past Accepting new patients
Community Medical Associates, Inc. Past Accepting new patients

Locations

3991 Dutchmans Ln
Ste 208
Louisville, KY 40207
Phone (502) 897-2440

4950 Norton Healthcare Blvd
Ste 303
Louisville, KY 40241
Phone (502) 394-6470

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

Organizations & group practices 5

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1417176249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3991 DUTCHMANS LN STE 208",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074723",
            "telephone_number": "502-899-6061",
            "fax_number": "502-899-6127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "TRISTAN",
        "middle_name": "DEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "KY",
            "license": "46118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100252740",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201069110",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT- NORTON RHEUMATOLOGY SPECIALISTS",
            "identifier": "50052639",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tblackburn62016@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "3991 Dutchmans Ln Ste 300",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402074700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3991 Dutchmans Ln Ste 300",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402074700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.