Individual provider Active NPI

Robert Steven Blackwelder

  • Acute Care Nurse Practitioner
  • Augusta, GA
National Provider Identifier
1558993576
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
RN249545 Issued in GA
Practice address
3623 J Dewey Gray Cir Ste 202
Augusta, GA 30909-6554
Phone
(706) 863-8181
NPI assigned
Feb 7, 2020
Last updated
Oct 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X RN249545 GA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

3623 J Dewey Gray Cir Ste 202
Augusta, GA 30909-6554

Mailing address

1120 15TH St
Augusta, GA 30912-0004
Phone (706) 721-4951

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20210216000563 GA Practitioner - Nurse Practitioner 7911312426 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Carolina School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Augusta Primary Care Services LLCGroup PAC ID 2466513874, 37 clinicians

Practice addresses (Care Compare)

3623 J Dewey Gray Cir
Suite 210
Augusta, GA 30909-6554
Phone (706) 855-0422

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Burn Critical Care Associates, LLC CurrentSince Feb 1, 2021 Accepting new patients
Augusta Primary Care Services LLC CurrentSince Jan 2, 2023 Accepting new patients

Locations

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

3623 J Dewey Gray Cir
Ste 202
Augusta, GA 30909
Phone (706) 863-8155

3623 J Dewey Gray Cir
Ste 210
Augusta, GA 30909
Phone (706) 651-5780

3624 J Dewey Gray Cir
Ste 304
Augusta, GA 30909

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: robert.blackwelder@hca5.eclinicaldirectplus.com

Organizations & group practices 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761177600000",
    "number": "1558993576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 15TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 J DEWEY GRAY CIR STE 202",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096554",
            "telephone_number": "706-863-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELDER",
        "first_name": "ROBERT",
        "middle_name": "STEVEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-07",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN249545",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.