Timothy Blackerby, D.P.M. – Podiatrist in Adrian, MI

Key facts

NPI: 1568554137
Entity type: Individual (NPI type 1)
Primary specialty: Podiatrist 213E00000X
License: L651126 (MI)
Practice address: 5415 Treat Hwy
Adrian, MI 49221
Phone: (517) 263-5813
NPI assigned: Sep 29, 2006
Sex: Male
Sole proprietor: Yes

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 and National Provider Directory roles.

At Home Health and Podiatry PLLC Podiatrist · Garden City, MI · NPI 1639463821

NPD (past) PODIATRIST
House Calls Physicians PLLC Home Health Agency · Allen Park, MI · NPI 1033273008

NPD (past)
Richard F Ambrose Jr DPM PC Foot & Ankle Surgery Podiatrist · Adrian, MI · NPI 1104106020

NPD (past)

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
L651126	MI	MD	Podiatrist

Practice roles

Organization	Specialty	Status	New patients
At Home Health and Podiatry PLLC	Podiatrist	Past since Nov 19, 2011	Accepting new patients
Richard F Ambrose Jr DPM PC		Past since Dec 15, 2011	Accepting new patients
House Calls Physicians PLLC		Past since May 19, 2011	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Podiatrist	213E00000X	L651126	MI	Yes

Addresses

Primary practice location

5415 Treat Hwy
Adrian, MI 49221

Mailing address

5415 Treat Hwy
Adrian, MI 49221
Phone (517) 263-5813

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568554137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 TREAT HWY",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "49221",
            "telephone_number": "517-263-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 TREAT HWY",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "49221",
            "telephone_number": "517-263-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKERBY",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "L651126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adrian, MI

All providers in Adrian, MI · Podiatrist in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.