Individual provider Active NPI

Kristine A Blackham, MD

Neuroradiology Physician
Cleveland, OH

National Provider Identifier

1487695219

Registry record updated Aug 27, 2010

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices3
NPI Registry JSON
Other providers in Cleveland, OH
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Neuroradiology PhysicianTaxonomy code 2085N0700X
License: 35084181 Issued in OH
Practice address: 11100 Euclid Ave
Cleveland, OH 44106-1736
Phone: (216) 844-1700
Fax: (216) 286-6341
NPI assigned: Jun 10, 2006
Last updated: Aug 27, 2010By the provider in NPPES
Sex: Female
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Aug 27, 2010

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

Specialties & licenses 15

Specialty (taxonomy)	Code	License	State	Primary
Nuclear Medicine Physician	207U00000X	35084181	OH
Nuclear Cardiology Physician	207UN0901X	35084181	OH
Nuclear Imaging & Therapy Physician	207UN0902X	35084181	OH
In Vivo & In Vitro Nuclear Medicine Physician	207UN0903X	35084181	OH
Body Imaging Physician	2085B0100X	35084181	OH
Neuroradiology Physician	2085N0700X	35084181	OH	Primary
Nuclear Radiology Physician	2085N0904X	35084181	OH
Pediatric Radiology Physician	2085P0229X	35084181	OH
Radiation Oncology Physician	2085R0001X	35084181	OH
Diagnostic Radiology Physician	2085R0202X	35084181	OH
Therapeutic Radiology Physician	2085R0203X	35084181	OH
Vascular & Interventional Radiology Physician	2085R0204X	35084181	OH
Diagnostic Ultrasound Physician	2085U0001X	35084181	OH
Diagnostic Neuroimaging (Radiology) Physician	2085D0003X	35084181	OH
Hospice and Palliative Medicine (Radiology) Physician	2085H0002X	35084181	OH

Addresses

Primary practice location

11100 Euclid Ave
Cleveland, OH 44106-1736

Mailing address

24701 Euclid Ave
3Rd Floor
Euclid, OH 44117-1714

Other identifiers 10

Identifier	Type	State	Issuer
0304914	Other	OH	BCMH
751556	Other	OH	AETNA
P00358779	Other	OH	RAILROAD MEDICARE
000000503569	Other	OH	ANTHEM
363360	Other	OH	WELLCARE
732926	Other	OH	BUCKEYE
2493707	Medicaid	OH
000000206509	Other	OH	UNISON
1023171400001	Medicaid	PA
1487695219	Other	MI	MI MEDICAID

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Enrolled
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
35084181	OH	MD	Neuroradiology Physician

Practice roles

Organization	Specialty	Status	New patients
University Imaging Inc	Nuclear Radiology	Past	Accepting new patients
Dr. Gary Pillow Auiologist & Co.		Past	Accepting new patients
University Radiologists of Cleveland Inc	Neuroradiology	Past	Accepting new patients

Organizations & group practices 3

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.

University Imaging Inc
- Nurse Practitioner
- Cleveland, OH
- NPI 1154374007
Nuclear Radiology
NPD (past)
University Radiologists of Cleveland Inc
- Nurse Practitioner
- Cleveland, OH
- NPI 1295788149
Neuroradiology
NPD (past)
Dr. Gary Pillow Auiologist & Co.
- Audiologist-Hearing Aid Fitter
- Low Moor, VA
- NPI 1174552178
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1487695219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24701 EUCLID AVE",
            "address_2": "3RD FLOOR",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441171714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061736",
            "telephone_number": "216-844-1700",
            "fax_number": "216-286-6341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKHAM",
        "first_name": "KRISTINE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "207UN0903X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, In Vivo & In Vitro Nuclear Medicine",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "OH",
            "license": "35084181",
            "primary": true
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085D0003X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "OH",
            "license": "35084181",
            "primary": false
        },
        {
            "code": "2085H0002X",
            "taxonomy_group": "",
            "desc": "Radiology, Hospice and Palliative Medicine",
            "state": "OH",
            "license": "35084181",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMH",
            "identifier": "0304914",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "751556",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00358779",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000503569",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "363360",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "732926",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2493707",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000206509",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023171400001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI MEDICAID",
            "identifier": "1487695219",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.