Jordan D Blackwill, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

68419 Issued in NE

Practice address

6901 N 72ND St
Omaha, NE 68122-1709

Phone

(402) 572-2121

NPI assigned

Apr 14, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, NE2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stewart Memorial Community HospitalGroup PAC ID 4486563707, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stewart Memorial Community Hospital Hospital, Lake City, IA, CCN 161350

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jblackwill944193@direct.unitypoint.org

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.

• Stewart Memorial Community Hospital

  • Critical Access Hospital
  • Lake City, IA
  • NPI 1063497188
  Medicare reassignment Care Compare group NPD
• Community Medical Center, Inc.

  • Critical Access Hospital
  • Falls City, NE
  • NPI 1881643484
  Medicare reassignment NPD
• Crawford County Memorial Hospital

  • Critical Access Hospital
  • Denison, IA
  • NPI 1578555116
  Medicare reassignment NPD
• Shenandoah Medical Center

  • Certified Registered Nurse Anesthetist
  • Shenandoah, IA
  • NPI 1497810972

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Stewart Memorial Community Hospital

  • Rural Health Clinic/Center
  • Lake City, IA
  • NPI 1285652909
  Medicare reassignment
• Shenandoah Medical Center

  • Community/Retail Pharmacy
  • Shenandoah, IA
  • NPI 1447937230
  NPD
• Shenandoah Medical Center

  • Emergency Medicine Physician
  • Shenandoah, IA
  • NPI 1497810956
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Stewart Memorial Community Hospital

  • Certified Registered Nurse Anesthetist
  • Lake City, IA
  • NPI 1831230747

  Nurse Anesthetist, Certified Registered

  NPD

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

• Stewart Memorial Community Hospital

  • Critical Access Hospital
  • Lake City, IA
  • NPI 1063497188
  Care Compare affiliation

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

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1992191225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16478 ERSKINE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681162523",
            "telephone_number": "402-779-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 N 72ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681221709",
            "telephone_number": "402-572-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWILL",
        "first_name": "JORDAN",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-14",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NE",
            "license": "68419",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D139751",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gillian Blackson
• Kayla Blackson
• Larece Blackstone
• Michael Blackstone Sr.
• Tanesha Lashell Blackwell
• Viridian Blackwood
• Angela L Blad
• Jameson Blad
• Kenneth L Blad, M.D.
• Lisa A Bladt, MD

• Certified Registered Nurse Anesthetist in Omaha, NE
• Providers in Omaha, NE by specialty
• Certified Registered Nurse Anesthetist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.