Tracy Marie Blackstock
Individual provider Active NPI Physical Therapist · Cleveland, MS
NPI 1932256641 · NPPES record last updated Dec 30, 2024
Key facts
- NPI
- 1932256641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT2182 (MS)
- Practice address
- 404 Classco PL
Cleveland, MS 38732-3000 - Phone
- (662) 843-3575
- Fax
- (662) 846-1397
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fox Rehab Agency Ms LLC
Practice addresses (Care Compare)
Starkville, MS 39759
Phone (877) 407-3422
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080605000431 | MS | Practitioner - Physical Therapist in Private Practice | 5395815187 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Rehab Agency Ms LLC | Physical Therapist | Current |
Accepting new patients |
| Therapy Innovations, Inc | Past |
Accepting new patients |
Locations
205 Industrial Cv
Ridgeland, MS 39157
Phone (601) 607-7820
74 Claiborne Way
Starkville, MS 39759
Phone (662) 268-9555
7 Carnegie Plz
Cherry Hill, NJ 08003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2182 | MS | Yes |
Addresses
Primary practice location
404 Classco PL
Cleveland, MS 38732-3000
Mailing address
404 Classco PL
Cleveland, MS 38732-3000
Phone (662) 843-3575
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03451326 | Medicaid | MS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehab Agency MS LLC |
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehab Agency MS LLC |
Other providers in Cleveland, MS
- Bradley Rex Baugh
- Matthew Bear
- Berry Chiropractic Family and Sports Rehabilitation Center, LLC
- Bethany Medical Clinic
- Bethany Medical Clinic, LLC
- Don Blackwood
- Mark Edward Blackwood
- Blake Surgical Association PLLC
- Roger Alan Blake
- Bolivar County Caa
All providers in Cleveland, MS · Physical Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.