Jeremy Aurbrey Blanzy, FNP-BC
Individual provider Active NPI Nurse Practitioner · Bristol, TN
NPI 1992285308 · NPPES record last updated Aug 15, 2018
Key facts
- NPI
- 1992285308
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 24573 (TN)
- Practice address
- 1 Medical Park Boulevard
Suite 400E
Bristol, TN 37620 - Phone
- (423) 844-5400
- Fax
- (423) 844-5434
- NPI assigned
- Aug 15, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 26
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- East Tennessee State University Quillen College of Medicine, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Campbell Clinic, PC
Practice addresses (Care Compare)
1 Medical Park Blvd
Suite 300E
Bristol, TN 37620-7497
Phone (423) 434-6300
1 Medical Park Blvd
Suite 400E
Bristol, TN 37620-7431
Phone (423) 844-5400
1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100
3 Professional Park Dr
Johnson City, TN 37604-6529
Phone (423) 434-6300
Hospital & facility affiliations
- Wellmont Bristol Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.83 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 72.77
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181023002642 | TN | Practitioner - Nurse Practitioner | 2365795291 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24573 | TN | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Campbell Clinic PC | Current |
Accepting new patients | |
| Campbell Clinic, PC | Nurse Practitioner | Current |
Accepting new patients |
| Highlands Neurosurgical Associates, PC | Adult Health | Current |
Accepting new patients |
| Campbell Clinic | Past | Accepting new patients |
Locations
1 Medical Park Blvd
Ste 400E
Bristol, TN 37620
Phone (423) 844-5400
1 Medical Park Blvd
Ste 300E
Bristol, TN 37620
Phone (423) 245-3161
1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111
Interoperability endpoints
- https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4
- jeremy.blanzy.1@1366.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 24573 | TN | |
| Nurse Practitioner | 363L00000X | 24573 | TN | Yes |
Addresses
Primary practice location
1 Medical Park Boulevard
Suite 400E
Bristol, TN 37620
Mailing address
1 Medical Park Boulevard
Suite 400E
Bristol, TN 37620
Phone (423) 844-5400
Other providers in Bristol, TN
- Lori Michelle Bish
- Rebecca A. Black
- Joshua David Blackburn
- Jonathan Dale Blankenship
- Robert H Blanton
- Christian Blazer
- Ashley Nicole Blevins
- Joel Blevins
- Lori Leigh Blevins
- Bloom Speech Therapy, LLC
All providers in Bristol, TN · Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2018. 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.
- Order and Referring (CMS).
- 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.