Maureen Mikho Blackburn, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901022231 Issued in MI

Practice address

117 W Paterson St
Kalamazoo, MI 49007-2581

Phone

(269) 349-2641

NPI assigned

Jun 1, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: maureen.thomas.p1@direct.gracehealthmi.nextgenshare.com

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.

• Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Kalamazoo, MI
  • NPI 1811065576
  Medicare reassignment NPD
• Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Kalamazoo, MI
  • NPI 1215768296
  NPD
• Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kalamazoo, MI
  • NPI 1023560331
  NPD

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1902334006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W PATERSON ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490072557",
            "telephone_number": "269-349-2641",
            "fax_number": "269-201-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W PATERSON ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490072581",
            "telephone_number": "269-349-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "MAUREEN",
        "middle_name": "MIKHO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-01",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901022231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dustin Anthony Bivins, DO
• Ashton Bjork
• BJR Ventures LLC
• Black Cat Counseling PLC
• Constance A Black-Pond
• Kayla Blackford
• Eric Scott Blackwell, M.D.
• Rebecca M Blades, NP
• Kari Lynn Blair, NNP-BC
• Kelly Blair

• Dentist in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.