Vaughn Blackburn DPM LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

36003708 Issued in OH

Legal business name

VAUGHN BLACKBURN DPM LLC

Practice address

5 W Main St
Amelia, OH 45102-1924

Phone

(513) 753-0500

Fax

(513) 986-0218

NPI assigned

Jun 23, 2015

Organization subpart

No

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

Authorized official

Name

Vaughn Daniel BlackburnNPI 1386925170

Title

DPM

Phone

(513) 753-0500

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vaughn Daniel Blackburn, DPM

  • Podiatrist
  • Amelia, OH
  • NPI 1386925170
  Medicare reassignment NPD Authorized official
• Karen Glandon, DPM

  • Podiatrist
  • Columbus, OH
  • NPI 1750384525
  NPD (past)

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1437531829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 PLEASANT AVE",
            "address_2": "STE 3",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450144670",
            "telephone_number": "513-829-9333",
            "fax_number": "513-858-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 W MAIN ST",
            "city": "AMELIA",
            "state": "OH",
            "postal_code": "451021924",
            "telephone_number": "513-753-0500",
            "fax_number": "513-986-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAUGHN BLACKBURN DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-23",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "VAUGHN",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "513-753-0500"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36003708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0139688",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100441860",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201368390A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Tirey
• Ashley Toller
• Amy Trent, NP
• Susan J Ullman
• Benjamin Vantreeck, PHARMD
• Kelli Nichole Votel
• Nicholas Vucurevich
• Jeff Wagner, PHARMD
• Kathryn Wainscott
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3342)

• Podiatrist in Amelia, OH
• Providers in Amelia, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.