NPIMap

Individual provider Active NPI

Deidra Blanks, M.D.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Fayetteville, NC
National Provider Identifier
1619170529
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
2006-00621 Issued in NC
Practice address
1839 Quiet CV
Fayetteville, NC 28304-3857
Phone
(910) 323-1463
Fax
(910) 323-1575
NPI assigned
Jun 7, 2007
Last updated
Jun 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 2006-00621 NC Primary
Otology & Neurotology Physician 207YX0901X 2006-00621 NC
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 2011003947 MO

Addresses

Primary practice location

1839 Quiet CV
Fayetteville, NC 28304-3857

Mailing address

1839 Quiet CV
Fayetteville, NC 28304-3857
Phone (910) 323-1463

Other identifiers 1

IdentifierTypeStateIssuer
1619170529MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120808000290 NC Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 3870763873 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery
Education
Brody School of Medicine at East Carolina University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fayetteville Otolaryngology Head and Neck Surgery P.a.Group PAC ID 2163421520, 7 clinicians
MCPC-28, LLCGroup PAC ID 2163929175, 8 clinicians

Practice addresses (Care Compare)

1839 Quiet CV
Fayetteville, NC 28304-3857
Phone (910) 323-1463

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.53 of 100Reported as individual
Quality
93.15
Promoting interoperability
91
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Fayetteville Otolaryngology Head and Neck Surgery P.a. Otology & Neurotology CurrentSince Dec 5, 2017 Accepting new patients
MCPC-28, LLC CurrentSince Sep 28, 2025 Accepting new patients
Dermone of North Carolina PA PastSince Jul 1, 2017 Accepting new patients

Locations

1839 Quiet Cv
Fayetteville, NC 28304
Phone (910) 323-1463

Interoperability endpoints

  • Direct secure messaging: dblanks128332@firsthealth.direct-ci.net
  • Direct secure messaging: deidrablanks@fo.allscriptsdirect.net

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1619170529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 QUIET CV",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043857",
            "telephone_number": "910-323-1463",
            "fax_number": "910-323-1575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 QUIET CV",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043857",
            "telephone_number": "910-323-1463",
            "fax_number": "910-323-1575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKS",
        "first_name": "DEIDRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-07",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NC",
            "license": "2006-00621",
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "NC",
            "license": "2006-00621",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MO",
            "license": "2011003947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619170529",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.