Shawna C Blackmon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA04131 Issued in TX

Practice address

3816 N University Dr
Nacogdoches, TX 75965-2011

Phone

(903) 939-7500

Fax

(903) 939-7728

NPI assigned

Oct 4, 2005

Last updated

Feb 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Other names 1

• Shawna C Russell Other name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ortholonestar PLLCGroup PAC ID 9931529062, 416 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Nacogdoches Medical Center Hospital, Nacogdoches, TX, CCN 450656
• Nacogdoches Memorial Hospital Hospital, Nacogdoches, TX, CCN 450508

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shawna.blackmon.1@15533.direct.athenahealth.com

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.

• Ortholonestar, PLLC

  • Orthopaedic Surgery Physician
  • Houston, TX
  • NPI 1942860176
  Medicare reassignment Care Compare group NPD
• TMH Physician Associates PLLC

  • Ophthalmology Physician
  • Houston, TX
  • NPI 1275779225
  Medicare reassignment NPD
• Ortholonestar, PLLC

  • Orthopaedic Surgery Physician
  • Tomball, TX
  • NPI 1073475679
  NPD
• TMH Physician Associates PLLC

  • Orthopaedic Surgery Physician
  • Spring, TX
  • NPI 1043061351
  NPD

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

• Nacogdoches County Hospital District

  dba NCHD Memorial Hospital

  • Rural Acute Care Hospital
  • Nacogdoches, TX
  • NPI 1801831748
  Care Compare affiliation
• TH Healthcare, LTD

  dba Nacogdoches Medical Center

  • General Acute Care Hospital
  • Nacogdoches, TX
  • NPI 1700885076
  Care Compare affiliation

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1487641536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3414 GOLDEN RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018336",
            "telephone_number": "903-939-7500",
            "fax_number": "903-939-7728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3816 N UNIVERSITY DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759652011",
            "telephone_number": "903-939-7500",
            "fax_number": "903-939-7728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3414 Golden Rd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757018336",
            "country_code": "US",
            "telephone_number": "903-939-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "SHAWNA",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04131",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA04131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8360ND",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206265503",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206265502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00743048",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206265501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8Y8693",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206265504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAWNA",
            "last_name": "RUSSELL",
            "middle_name": "C",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kimberly Danielle Biggs-Lewis, D.D.S.
• Bio-Medical Applications of Texas, Inc. (Fresenius Kidney Care Nacogdoches Dialysis Center)
• Aimee Bird, MS, CCC/SLP
• Elisabeth Anne Bird, ATC
• Deanna Ellen Bishop, FNP-BC
• Blake G. Sinclair, DDS II, P.a.
• Tammy Blank, EXECUTIVE DIRECTOR
• BMW Healthcare, Inc (Westridge Manor)
• Linda Stark Bobo, PHD, ATC, LAT
• William Parker Bobo, ATC, LAT

• Physician Assistant in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.