NPIMap

Individual provider Active NPI

Lori A Blackburn, PAC

  • Medical Physician Assistant
  • Morristown, TN
National Provider Identifier
1780791749
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1739 Issued in TN
Practice address
305 N Bellwood Rd
Morristown, TN 37814-1120
Phone
(423) 587-8300
Fax
(423) 289-1609
NPI assigned
Aug 24, 2006
Last updated
Sep 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1739 TN Primary

Addresses

Primary practice location

305 N Bellwood Rd
Morristown, TN 37814-1120

Mailing address

305 N Bellwood Rd
Morristown, TN 37814-1120
Phone (423) 587-8300

Other identifiers 1

IdentifierTypeStateIssuer
1521156MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lori.blackburn.1@4694.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20090820000350 TN Practitioner - Physician Assistant 9739111485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Knoxville Hma Physician Management, LLCGroup PAC ID 6103097316, 118 clinicians

Practice addresses (Care Compare)

10810 Parkside Dr
Knoxville, TN 37934-1981

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.07 of 100Reported as apm
Quality
73.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1739TNMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lori.blackburn.1@4694.direct.athenahealth.com
  • Direct secure messaging: lori.blackburn.2@4694.direct.athenahealth.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 4

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1780791749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 N BELLWOOD RD",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378141120",
            "telephone_number": "423-587-8300",
            "fax_number": "423-289-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 N BELLWOOD RD",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378141120",
            "telephone_number": "423-587-8300",
            "fax_number": "423-289-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "LORI",
        "middle_name": "A",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "1739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521156",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lori.blackburn.1@4694.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct address",
            "address_1": "305 N Bellwood Rd",
            "city": "Morristown",
            "state": "TN",
            "country_code": "US",
            "postal_code": "378141120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

Verify at the official NPI Registry.