Steve L Blackburn, MHA, MPAS, PA-C
Individual provider Active NPI Surgical Physician Assistant · Menomonee Falls, WI
NPI 1487084422 · NPPES record last updated Aug 15, 2016
Key facts
- NPI
- 1487084422
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 3230-023 (WI)
- Practice address
- W180N8085 Town Hall Rd
Heart & Vascular Center Clinic
Menomonee Falls, WI 53051-3518 - Phone
- (262) 532-1300
- Fax
- (262) 532-1340
- NPI assigned
- Nov 12, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Louisiana State University School of Medicine in Shreveport, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ascension Medical Group-Southeast Wisconsin Inc
Midwest Critical Care SC
Columbia St Marys Hospital Milwaukee Inc
Practice addresses (Care Compare)
13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400
19475 W N Ave
Brookfield, WI 53045-4199
Phone (414) 453-7418
2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000
2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000
2350 N Lake Dr
Milwaukee, WI 53211-4528
3803 Spring St
Mount Pleasant, WI 53405-1660
Phone (262) 687-4011
801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600
Hospital & facility affiliations
- Ascension Columbia St Marys Hospital Milwaukee
- Ascension SE Wisconsin Hospital
- Ascension All Saints Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131211001900 | WI | Practitioner - Physician Assistant | 4981831278 | Reassigns benefits to 8 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3230-023 | WI | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients | |
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients | |
| Ascension Medical Group-Southeast Wisconsin Inc | Physician Assistant | Current |
Accepting new patients |
| Columbia St. Mary'S Hospital Milwaukee Inc | Current |
Accepting new patients | |
| Marshfield Clinic Inc | Current |
Accepting new patients | |
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current |
Accepting new patients | |
| MCHS Hospitals Inc | Current | Accepting new patients | |
| Columbia St. Mary'S Hospital Milwaukee, Inc | Current |
Accepting new patients | |
| Prohealth Medical Group Inc | Past | Accepting new patients |
Locations
1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950
1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435
13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400
3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200
10101 S 27th St
Franklin, WI 53132
Phone (414) 325-4700
W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060
1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111
W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000
10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080
5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089
2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932
3803 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-3973
500 S Oakwood Rd
Oshkosh, WI 54904
Phone (920) 223-0501
2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220
13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300
201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228
840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540
1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990
8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100
801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600
Interoperability endpoints
- steven.blackburn@marshfieldclinichealthsystem.cernerdirect.com
- https://fhir-myrecord.cerner.com/r4/67ff075a-8289-4f2d-a8eb-5dc1f0d954ab/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3230-023 | WI | |
| Surgical Physician Assistant | 363AS0400X | 3230-023 | WI | Yes |
Addresses
Primary practice location
W180N8085 Town Hall Rd
Heart & Vascular Center Clinic
Menomonee Falls, WI 53051-3518
Mailing address
W180N8085 Town Hall Rd
Heart & Vascular Center Clinic
Menomonee Falls, WI 53051-3518
Phone (262) 532-1300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487084422 | Medicaid | WI |
Other providers in Menomonee Falls, WI
- Jenna Biesterfeld
- Bioresolutions LLC
- Mary Margaret Birschbach
- Eyad Bittar
- Samantha Goeke Blackburn
- David Warren Blanchard
- Ryan Blaney
- Patricia Jean Blankenmeyer Kohl
- Kathleen Sue Blocher
- Melissa Block
All providers in Menomonee Falls, WI · Surgical Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.