Individual provider Active NPI

Kathryn Marie Blackmore, APRN, FNP-C

  • Family Nurse Practitioner
  • Troy, OH
National Provider Identifier
1649749599
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
023364 Issued in OH
Practice address
731 W Market St
Troy, OH 45373-3003
Phone
(425) 861-5425
NPI assigned
Nov 21, 2018
Last updated
Dec 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 023364 OH Primary
Registered Nurse 163W00000X 434484 OH

Addresses

Primary practice location

731 W Market St
Troy, OH 45373-3003

Mailing address

2300 Greenlawn Dr
Troy, OH 45373-4359
Phone (614) 546-6745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20190116003101 OH Practitioner - Nurse Practitioner 3274879911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Ohio State University College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Little Clinic of Ohio LLCGroup PAC ID 7719087584, 212 clinicians

Practice addresses (Care Compare)

780 Northwoods Blvd
Vandalia, OH 45377-9462
Phone (937) 665-0324

Merit-based Incentive Payment System (MIPS)

Final score
86.78 of 100Reported as group
Quality
71.59
Promoting interoperability
100
Improvement activities
40
Cost
84.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
434484OHMDRegistered Nurse
023364OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Little Clinic of Ohio LLC Family CurrentSince Jun 5, 2019 Accepting new patients

Locations

199 Graceland Blvd
Columbus, OH 43214
Phone (614) 410-2814

731 W Market St
Troy, OH 45373
Phone (937) 339-8441

780 Northwoods Blvd
Vandalia, OH 45377
Phone (937) 264-2420

Interoperability endpoints

  • Direct secure messaging: kathryn.satkowski@krogerhealth.eclinicaldirectplus.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1649749599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 GREENLAWN DR",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453734359",
            "telephone_number": "614-546-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 W MARKET ST",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453733003",
            "telephone_number": "425-861-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMORE",
        "first_name": "KATHRYN",
        "middle_name": "MARIE",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-21",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "023364",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "434484",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, OH

Sources for this page

Verify at the official NPI Registry.