Kelly Lane Blair, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1706 Issued in TN

Practice address

708 W Forest Ave
Jackson, TN 38301-3901

Phone

(731) 425-4930

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Tennessee Medical Group IncGroup PAC ID 3971781006, 190 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.74 of 100Reported as apm

Quality

85.23

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kblair17727@directepic.wth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Tennessee Medical Group Inc

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1053615955
  Medicare reassignment Care Compare group NPD
• WT Medical Associates

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1295223279
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248998400000",
    "number": "1891711131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP",
            "address_2": "SUITE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-660-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013901",
            "telephone_number": "731-425-4930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "KELLY",
        "middle_name": "LANE",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2009-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "1706",
            "primary": true
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "TN",
            "license": "1706",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry M Blackford, PMHNP-BC, FNP-BC
• Vivian Blackmer
• Gavin Blackwell
• Jillian Blackwell, RBT
• Laura Elizabeth Blackwell
• Abigail Blake, RBT
• Jeremy T. Blake, M.D.
• Jase Blakney, PTA
• Derek Blankenship, PA-C
• Joe David Blankenship, M.D.

• Clinical Psychologist in Jackson, TN
• Providers in Jackson, TN by specialty
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; 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.