Active NPI
Michelle Lila Blitstein, M.S. R.D.
- Metabolic Nutrition Registered Dietitian
- Charlotte, NC
National Provider Identifier
1801079298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Metabolic Nutrition Registered Dietitian
- License
- L001566
- Practice address
- 4812 Carmel Park Dr
Charlotte, NC 28226-5131 - Phone
- (704) 491-5616
- Fax
- (704) 442-6360
- NPI assigned
- Dec 9, 2007
- Last updated
- Feb 24, 2010
- 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 |
|---|---|---|---|---|
| Metabolic Nutrition Registered Dietitian | 133VN1006X | L001566 | NC | Primary |
Addresses
Primary practice location
4812 Carmel Park Dr
Charlotte, NC 28226-5131
Mailing address
4812 Carmel Park Dr
Charlotte, NC 28226-5131
Phone (704) 491-5616
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2993129 | Other | NC | MRCE NC PTAN |
| 142T8 | Other | NC | BCBS NORTH CAROLINA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100222000795 | NC | Practitioner - Registered Dietitian Or Nutrition Professional | 4385703289 | Practice locations: Cornelius, NC |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266969600000",
"number": "1801079298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4812 CARMEL PARK DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282265131",
"telephone_number": "704-491-5616",
"fax_number": "704-892-2212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4812 CARMEL PARK DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282265131",
"telephone_number": "704-491-5616",
"fax_number": "704-442-6360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLITSTEIN",
"first_name": "MICHELLE",
"middle_name": "LILA",
"credential": "M.S. R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-09",
"last_updated": "2010-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1006X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Metabolic",
"state": "NC",
"license": "L001566",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MRCE NC PTAN",
"identifier": "2993129",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NORTH CAROLINA",
"identifier": "142T8",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
- Blissful Living Senior Care Inc
- Blissfull Living Care LLC (Griswold Home Care for Southeast Charlotte)
- Blissfully Supported Enterprises Inc
- Blissfully Supported LLC
- Maxwell Blitstein, D.C
- William Mitchell Blitstein, DC, FASA, CCSP
- Annalisa Block
- Jared G Block, M.D.
- Courtney Vann Blocker, FNP-C
- Michael Edward Blocker, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.