Katherine Ann Blackwell

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1209 10TH St
Port Huron, MI 48060-5262

Phone

(810) 985-8170

NPI assigned

Jan 6, 2012

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

Other identifiers 1

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Clair Medical P.CGroup PAC ID 1850295916, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Port Huron Hospital, Port Huron, MI, CCN 230216
• Lake Huron Medical Center Hospital, Port Huron, MI, CCN 230031

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• St. Clair Medical P.C

  • Family Medicine Physician
  • Port Huron, MI
  • NPI 1073563102

  MI

  Medicare reassignment Care Compare group

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

• McLaren Port Huron

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1982685384

  Hospital

  Care Compare affiliation
• Prime Healthcare Services-Port Huron LLC

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1306227764

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482105600000",
    "number": "1942570973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 10TH ST",
            "address_2": "SUITE D",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605262",
            "telephone_number": "810-898-5817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 10TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605262",
            "telephone_number": "810-985-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-06",
        "last_updated": "2016-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "700H231390",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Michigan, Inc.
• Helen Birkbeck, APRN
• Jill Anne Biskner, LLMSW
• Agnes Anne Bissett, LMSW
• James Black, MA, BS
• Lori Blair
• Sherry Blais, RN
• Tara Lynn Blank, PA-C
• Steven Alexander Bliss, RN
• Carol Ann Bloink

• All providers in Port Huron, MI
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; 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.
• 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.