Active NPI
Thomas L Blackstone, MD
- Pediatrics Physician
- Wilmington, NC
National Provider Identifier
1912094301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 17469
- Practice address
- 3505 Converse Dr
Ste 200
Wilmington, NC 28403-6132 - Phone
- (910) 392-5634
- Fax
- (910) 392-5654
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 17469 | NC | Primary |
Addresses
Primary practice location
3505 Converse Dr
Ste 200
Wilmington, NC 28403-6132
Mailing address
PO Box 647
Hope Mills, NC 28348-0647
Phone (910) 483-7337
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4359214 | Other | NC | AETNA |
| 8915986 | Medicaid | NC | |
| 1542826 | Other | NC | WELLPATH |
| 1912094301 | Other | NC | DOCTORS DIRECT |
| 15986 | Other | NC | BCBS OF NC |
| 1912094301 | Other | NC | HEALTHNET FEDERAL SERVICES |
| 1912094301 | Other | NC | HUMANA |
| 296275 | Other | NC | MEDCOST |
| FH1101875 | Other | NC | FIRST CAROLINA CARE |
| 12337276 | Other | NC | MULTIPLAN |
| 4550753 | Other | NC | COVENTRY NATIONAL - COVENTRY PPO |
| 1409483 | Other | NC | UNITED HEALTHCARE |
| 1542826 | Other | NC | COVENTRY OF THE CAROLINAS |
| 1791139 | Other | NC | CIGNA GREATWEST |
| 1912094301 | Other | NC | HEALTHSMART |
| 1912094301 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17469 | NC | MD | Massage Therapist |
Interoperability endpoints
- tblackstone1243600@direct.novanthealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464825600000",
"number": "1912094301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 647",
"city": "HOPE MILLS",
"state": "NC",
"postal_code": "283480647",
"telephone_number": "910-483-7337",
"fax_number": "910-483-0648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3505 CONVERSE DR",
"address_2": "STE 200",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284036132",
"telephone_number": "910-392-5634",
"fax_number": "910-392-5654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKSTONE",
"first_name": "THOMAS",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2016-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "17469",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4359214",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8915986",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLPATH",
"identifier": "1542826",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DOCTORS DIRECT",
"identifier": "1912094301",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "15986",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET FEDERAL SERVICES",
"identifier": "1912094301",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "1912094301",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "296275",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST CAROLINA CARE",
"identifier": "FH1101875",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "12337276",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY NATIONAL - COVENTRY PPO",
"identifier": "4550753",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1409483",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY OF THE CAROLINAS",
"identifier": "1542826",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA GREATWEST",
"identifier": "1791139",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSMART",
"identifier": "1912094301",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1912094301",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.