Rickey Allen Blackburn Jr., CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-131157 Issued in AL

Practice address

102 Edwina St
Evergreen, AL 36401-3319

Phone

(251) 578-0220

Fax

(251) 578-0223

NPI assigned

Aug 4, 2017

Last updated

Jul 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evergreen Medical Center LLCGroup PAC ID 6305942145, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Evergreen Medical Center Hospital, Evergreen, AL, CCN 010148
• Andalusia Health Hospital, Andalusia, AL, CCN 010036

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Evergreen Medical Center, LLC

  • Rural Health Clinic/Center
  • Georgiana, AL
  • NPI 1619559812
  Medicare reassignment Care Compare group NPD
• Evergreen Medical Center LLC

  dba Evergreen Primary Care

  • Rural Health Clinic/Center
  • Evergreen, AL
  • NPI 1427366871
  NPD (past)

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

• Community Hospital of Andalusia LLC

  dba Andalusia Health

  • General Acute Care Hospital
  • Andalusia, AL
  • NPI 1821078494
  Care Compare affiliation
• Evergreen Medical Center LLC

  • General Acute Care Hospital
  • Evergreen, AL
  • NPI 1891770368
  Care Compare affiliation

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

{
    "created_epoch": "1501804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1841715430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 EDWINA ST",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013319",
            "telephone_number": "251-578-0220",
            "fax_number": "251-578-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 EDWINA ST",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013319",
            "telephone_number": "251-578-0220",
            "fax_number": "251-578-0223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Patterson Ave",
            "address_purpose": "LOCATION",
            "city": "Georgiana",
            "state": "AL",
            "postal_code": "360336628",
            "country_code": "US",
            "telephone_number": "334-376-2005",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Crestview Ave",
            "address_purpose": "LOCATION",
            "city": "Evergreen",
            "state": "AL",
            "postal_code": "364013333",
            "country_code": "US",
            "telephone_number": "251-578-2480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "RICKEY",
        "middle_name": "ALLEN",
        "name_suffix": "Jr.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-04",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-131157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "evergreenmedical.org",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Web",
            "address_1": "102 Edwina St",
            "city": "Evergreen",
            "state": "AL",
            "country_code": "US",
            "postal_code": "364013319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Bayside Orthopaedic & Rehabilitation Center, P.C. (Bayside Orthopaedic, Sports Medicine & Rehabilitation Center)
• Tara Bowman, RD
• Sylvia Annette Brinson
• Willis Brown
• Latonya Burroughs, MS
• City Drug Store, Inc.

• Family Nurse Practitioner in Evergreen, AL
• Providers in Evergreen, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.