Individual provider Active NPI

David Justin Blalock, ARNP

  • Family Nurse Practitioner
  • Wauchula, FL
National Provider Identifier
1922076124
Registry record updated Aug 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP2833192 Issued in FL
Practice address
515 Carlton St
Wauchula, FL 33873-3407
Phone
(863) 773-6606
NPI assigned
Mar 14, 2006
Last updated
Aug 26, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP2833192 FL Primary

Addresses

Primary practice location

515 Carlton St
Wauchula, FL 33873-3407

Mailing address

515 Carlton St
Wauchula, FL 33873-3407
Phone (863) 773-6606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20031218000915 FL Practitioner - Nurse Practitioner 6608773536 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health System-Sunbelt IncGroup PAC ID 0749232445, shared by 8 NPIs, 100 clinicians

Practice addresses (Care Compare)

515 Carlton St
Wauchula, FL 33873-3407
Phone (863) 773-6606

533 Carlton St
Wauchula, FL 33873-3407
Phone (863) 773-3101

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP2833192FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System-Sunbelt Inc CurrentSince Jun 1, 2011 Accepting new patients
Adventist Health System-Sunbelt Inc Family CurrentSince Oct 17, 2011 Accepting new patients
Adventist Health System-Sunbelt Inc CurrentSince Jun 1, 2011 Accepting new patients
Adventist Health System-Sunbelt Inc Current Accepting new patients
Paragon Emergency Services LLC CurrentSince May 1, 2011 Accepting new patients
Emergency Medicine of Florida, Inc. Past Accepting new patients
Paragon Contracting Services LLC Past Accepting new patients

Locations

206 2nd St E
Bradenton, FL 34208
Phone (941) 745-7202

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

1210 US Highway 27 N
Lake Placid, FL 33852
Phone (863) 465-3777

4101 Sun N Lake Blvd
Sebring, FL 33872

4200 Sun N Lake Blvd
Sebring, FL 33872
Phone (863) 314-4406

515 Carlton St
Wauchula, FL 33873
Phone (863) 773-6606

522 Carlton St
Wauchula, FL 33873
Phone (863) 773-0975

735 S 5th Ave
Wauchula, FL 33873
Phone (863) 402-3402

Interoperability endpoints

  • Direct secure messaging: dblalock617835@adventhealth.direct-ci.com

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377475200000",
    "number": "1922076124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 CARLTON ST",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338733407",
            "telephone_number": "863-773-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 CARLTON ST",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338733407",
            "telephone_number": "863-773-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "DAVID",
        "middle_name": "JUSTIN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2013-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP2833192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauchula, FL

Sources for this page

Verify at the official NPI Registry.