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DR. DEMETRIOUS J. BLACKMON M.D. NPI 1578592994


NPI Information

NPI: 1578592994
Provider Name: DR. DEMETRIOUS J. BLACKMON, M.D.
Classification: Internal Medicine - 207RN0300X
Entity Type: Individual

Specialization: Nephrology

PECOS Registration: Yes

Address:
250 VILLAGE CENTER PWKY
SUITE 100
STOCKBRIDGE, GA
ZIP 30281
Phone: (678) 289-0508
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DR. Demetrious J. Blackmon, M.D. is a nephrology internal medicine in Stockbridge, GA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. DR. Demetrious J. Blackmon, M.D. NPI is 1578592994. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

250 VILLAGE CENTER PWKY
SUITE 100
STOCKBRIDGE, GA
ZIP 30281-044
Phone: (678) 289-0508
Fax: (678) 289-0124

The NPI 1578592994 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Dialysis services (4 or more physician visits per month), patient 20 years of age and older (HCPCS:90960)
  • Dialysis services (2-3 physician visits per month), patient 20 years of age and older (HCPCS:90961)
  • Home dialysis services per month, patient 20 years of age or older (HCPCS:90966)
  • Hemodialysis procedure with one physician evaluation (HCPCS:90935)
  • Dialysis services (1 physician visit per month), patient 20 years of age and older (HCPCS:90962)

The enumeration date for this NPI number is 6/30/2006 and was last updated on 3/4/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineMD38696TENNESSEENo
2207RN0300XInternal MedicineNephrology57778GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1662769049AMEDICAIDGEORGIA
2662769049FMEDICAIDGEORGIA
33334458MEDICAIDTENNESSEE
43334458MEDICARE PINTENNESSEE
5009934159MEDICAIDALABAMA
6P00254515OTHERTENNESSEERAILROAD MEDICARE
7I 41374MEDICARE UPINGEORGIA
84111806OTHERTENNESSEEBCBS OF TENNESSEE
9581365705OTHERGEORGIACHAMPUS
104152444OTHERTENNESSEEBLUE CROSS
113334459MEDICAIDTENNESSEE
123334459MEDICARE PINTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.