Active NPI
Tracy Primus-Blackmon
- Licensed Practical Nurse
- Akron, OH
National Provider Identifier
1760931604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LPN.143750.MEDS-IV
- Practice address
- 985 Gorge Blvd
Akron, OH 44310-2407 - Phone
- (330) 761-2665
- Fax
- (330) 761-2661
- NPI assigned
- Oct 3, 2016
- Last updated
- Oct 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LPN.143750.MEDS-IV | OH | Primary |
Addresses
Primary practice location
985 Gorge Blvd
Akron, OH 44310-2407
Mailing address
534 Merriman Rd
Akron, OH 44303-1644
Phone (330) 761-2665
Other names 1
- Mrs. Tracy Primus-Blackmon
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPN.143750.MEDS-IV | OH | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Asian Services in Action, Inc | Past | Accepting new patients |
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.
-
dba International Community Health Center- Cleveland
- Federally Qualified Health Center (FQHC)
- Cleveland, OH
- NPI 1386286011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475452800000",
"number": "1760931604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "534 MERRIMAN RD",
"city": "AKRON",
"state": "OH",
"postal_code": "443031644",
"telephone_number": "330-761-2665",
"fax_number": "330-761-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "985 GORGE BLVD",
"city": "AKRON",
"state": "OH",
"postal_code": "443102407",
"telephone_number": "330-761-2665",
"fax_number": "330-761-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIMUS-BLACKMON",
"first_name": "TRACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-03",
"last_updated": "2016-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "LPN.143750.MEDS-IV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRACY",
"last_name": "PRIMUS-BLACKMON",
"prefix": "MRS.",
"credential": "LPN",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Akron, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.