DR. ERIC SCOTT BLACKWELL (NPI# 1114970373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114970373 |
| Entity Type | Individual |
| Full Name | DR. ERIC SCOTT BLACKWELL |
| Credential | M.D. |
| Practice Address |
1535 Gull Rd Msb 015 Kalamazoo MI 49048-1650 |
| Practice Telephone | 2692266933 |
| Practice Fax Number | 2692266949 |
| Mailing Telephone | 2692266933 |
| Mailing Fax Number | 2692266949 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-10-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 4301072041 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 104275172 | 05 | |
| MI | BLUE CROSS BLUE SHIELD | EB072041 | 01 |
| MI | BCBS GROUP-THREE RIVERS HEALTH | 700G560080 | 01 |
| MI | 104277720 | 05 | |
| MI | 4321103-10 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316477136 | Eric Blackwell | Driver | 248 Circle Dr, South Hill, VA 23970 | 2017-06-14 |
| 1932677333 | Eric Blackwell | Counselor | 770 Woodlane Rd, Westampton, NJ 08060-3804 | 2018-11-05 |
| Street Address |
1535 GULL RD MSB 015 |
| City | KALAMAZOO |
| State | MI |
| Zip Code | 49048-1650 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649273855 | Umakant Shivlal Doctor | Internal Medicine | 1535 Gull Rd, Ste 110, Kalamazoo, MI 49048-1630 | 2005-05-23 |
| 1417489931 | Katheryn Elisabeth Clark | Advanced Practice Midwife | 1535 Gull Rd, Suite 250, Kalamazoo, MI 49048-1650 | 2017-04-03 |
| 1649714452 | Susan Doan | Physician Assistant | 1535 Gull Rd, Msb 015, Kalamazoo, MI 49048-1650 | 2016-12-13 |
| 1144673070 | Kristen Dib | Advanced Practice Midwife | 1535 Gull Rd, Kalamazoo, MI 49048-1650 | 2016-07-15 |
| 1366897670 | Kalamazoo Acute Care Specialists Plc | Emergency Medicine | 1535 Gull Rd, Msb 015, Kalamazoo, MI 49048-1650 | 2016-04-25 |
| 1841670510 | Elizabeth Bobo | Nurse Practitioner | 1535 Gull Rd, Suite 150, Kalamazoo, MI 49048-1650 | 2015-06-08 |
| 1194163246 | Tabitha Jane Ewert | Physician Assistant | 1535 Gull Rd, Suite 200, Kalamazoo, MI 49048-1650 | 2013-06-11 |
| 1578858676 | Michael Robert Mcbride | Emergency Medicine | 1535 Gull Rd, Msb 015, Kalamazoo, MI 49048-1650 | 2011-06-16 |
| 1295979474 | Lewis Jeremy Johnson | Surgery | 1535 Gull Rd, Suite 150, Kalamazoo, MI 49048-1650 | 2009-05-01 |
| 1134361215 | Michael Lee Adix II | Radiology | 1535 Gull Rd, Suite #200, Kalamazoo, MI 49048-1650 | 2009-04-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790214146 | Sally Leigh Weigandt | Technician, Other | 5438 Lucerne Ave, Kalamazoo, MI 49048 | 2017-06-08 |
| 1437606670 | Amanda Ezekiel | Advanced Practice Midwife | 1523 Gull Rd Ste 250, Kalamazoo, MI 49048 | 2016-09-06 |
| 1700238987 | Brittany Bittenbender | Technician, Other | 5840 E Cork St, Kalamazoo, MI 49048 | 2016-07-12 |
| 1255747176 | Araena Payton | Early Intervention Provider Agency | 1313 Hotop Ave, Kalamazoo, MI 49048 | 2014-07-11 |
| 1508297151 | Hope Network Eastwood House | Residential Treatment Facility, Physical Disabilities | 2236 Brook Drive, Kalamazoo, MI 49048 | 2013-12-09 |
| 1457780314 | Hope Network Rehabilitation Servicesq | Residential Treatment Facility, Physical Disabilities | 2236 Brooke Drive, Kalamazoo, MI 49048 | 2013-11-01 |
| 1467889576 | Aaron Van Heest | Social Worker | 813 Chrysler St., Kalamazoo, MI 49048 | 2013-10-03 |
| 1760737308 | Salem A. Salem | Internal Medicine | Ascension Borgess Hospital, 1521 Gull Rd, Kalamazoo, MI 49048 | 2012-07-19 |
| 1356523229 | Borgess Medical Center | Psychiatry & Neurology | 1521 Gull Road, Kalamazoo, MI 49048 | 2007-12-03 |
| 1629290135 | Robert Claude Gano | Dentist | 5462 Gull Rd Suite 7, Kalamazoo, MI 49048 | 2007-05-03 |
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| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184002727 | Cayla Williams | Emergency Medicine | 1009 Coolidge Ave, Kalamazoo, MI 49006-2119 | 2015-05-15 |
| 1063847416 | Fred Lee Wedeking | Emergency Medicine | 1034 Crown St, Kalamazoo, MI 49006-2102 | 2013-09-04 |
| 1609175868 | Timothy Roy Trichler Jr. | Emergency Medicine | 1535 Gull Rd # Msb015, Kalamazoo, MI 49048-1650 | 2011-03-26 |
| 1568663185 | Jeremiah Joseph Ledesma | Emergency Medicine | 125 S Kalamazoo Mall Ste 204, Kalamazoo, MI 49007-4869 | 2007-05-30 |
| 1295886802 | Scott David Cline | Emergency Medicine | 1850 Whites Rd Ste 3, Kalamazoo, MI 49008-4801 | 2007-01-12 |
| 1710060066 | Jyothirmai Bobba | Emergency Medicine | 5973 Beatrice Dr, Kalamazoo, MI 49009-9583 | 2006-10-23 |
| 1437169034 | Theresa A Kordish | Emergency Medicine | 2121 Hudson Avenue, Suite 102, Kalamazoo, MI 49008 | 2006-08-08 |
| 1952351165 | Paul Rehkopf | Emergency Medicine | 1917 Argyle Ave, Kalamazoo, MI 49008-2213 | 2006-05-10 |
| 1578522173 | Zbigniew Mark Srodulski | Emergency Medicine | 1850 Whites Rd, Suite 3, Kalamazoo, MI 49008-4801 | 2006-03-22 |
| 1124006465 | Charles M Dwan | Emergency Medicine | 1634 Gull Rd, Kalamazoo, MI 49048-1632 | 2006-01-06 |
| Find all providers in KALAMAZOO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.