Tracy Marie Blackstock

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT2182 Issued in MS

Practice address

404 Classco PL
Cleveland, MS 38732-3000

Phone

(662) 843-3575

Fax

(662) 846-1397

NPI assigned

Jan 4, 2007

Last updated

Dec 30, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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 LLCGroup PAC ID 2769841782, 66 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Fox Rehab Agency Ms LLC

  • Physical Therapist
  • Starkville, MS
  • NPI 1336839000
  Medicare reassignment Care Compare group NPD
• Therapy Innovations, Inc

  • Speech-Language Pathologist
  • Cleveland, MS
  • NPI 1275633588
  NPD (past) Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1932256641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 CLASSCO PL",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387323000",
            "telephone_number": "662-843-3575",
            "fax_number": "662-846-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 CLASSCO PL",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387323000",
            "telephone_number": "662-843-3575",
            "fax_number": "662-846-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTOCK",
        "first_name": "TRACY",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT2182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "Fox Rehab Agency MS LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "74 Claiborne Way",
            "city": "Starkville",
            "state": "MS",
            "country_code": "US",
            "postal_code": "397598544",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "Fox Rehab Agency MS LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "205 Industrial Cv",
            "city": "Ridgeland",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391572715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bradley Rex Baugh, MD
• Matthew Bear, DO
• Berry Chiropractic Family and Sports Rehabilitation Center, LLC
• Bethany Medical Clinic
• Bethany Medical Clinic, LLC
• Mark Edward Blackwood, MD
• Blake Surgical Association PLLC
• Roger Alan Blake, M.D.
• Bolivar County Caa
• Bolivar County Council on Aging, Inc.

• Physical Therapist in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.