Lisa R Blackrick

Orthopaedic Trauma Memorial Hospital Jacksonville NPI1386846871

Summary

About

Lisa R Blackrick specialises in Orthopaedic Trauma. She currently works at Memorial Hospital Jacksonville in Florida.

Provider Details

NPI Number 1386846871
Provider Name Lisa R Blackrick
Credential
Specialization Orthopaedic Trauma
Medical School Name Clvlnd Clinic Lerner College Of Med Of Case Wstn Rsv University
Graduation Year 2004
Gender F
Entity Type Individual
PAC ID by PECOS 2163572272
Professional Enrollment ID I20200406001701
Enumeration Date 06/05/2007
Last Update Date 09/14/2020

Contact Details

Business Practice address 3627 UNIVERSITY BLVD S STE 550, Jacksonville,
32216-7401 Florida View on Google Map
Business Practice phone 904-379-5986
Business Practice fax 904-551-0282
Mailing address PO BOX 370, Fortson,
31808-0370 Georgia View on Google Map
Other phone
Other fax 706-494-3008
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for Lisa R Blackrick Update NPI

Payments

Total Payment Worth

$53,409.68
from 74 payments in the last 6 years

Total Cash or Cash Equivalent

$47,987.43
from 51 payments in the last 6 years

Total In-kind Items & Services

$5,422.25
from 23 payments in the last 6 years

Hospital Affilitation

Memorial Hospital Jacksonville in Jacksonville

Jacksonville, Florida

Education & Training

Clvlnd Clinic Lerner College Of Med Of Case Wstn Rsv University

Orthopaedic Trauma, 2004

Group Affiliation

Organization Name PECOS PAC ID Members
Hughston Clinic Southeast Pc 9234423971 46
Newsletter for Healthcare Professionals

Provider Taxonomy Details

Primary Taxonomy
Taxonomy
License No.
ME144788 (Florida)

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1386846871
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor N
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Blackrick
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name Lisa
The first name of the provider, if the provider is an individual.
Provider Credential Text MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address PO BOX 370
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Fortson
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Georgia
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 31808-0370
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Fax Number 706-494-3008
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider First Line Business Practice Location Address 3627 UNIVERSITY BLVD S STE 550
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Jacksonville
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Florida
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 32216-7401
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 904-379-5986
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number 904-551-0282
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date 06/05/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 09/14/2020
The date that a record was last updated or changed.
Provider Gender Code F
The code designating the provider's gender if the provider is a person.
Provider Gender Female
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 207XX0801X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the evaluation and management of acute orthopaedic injuries, evaluation and treatment of post-traumatic deformities and nonunions, acute and delayed reconstruction of pelvic and acetabular fractures, as well as osteotomy in the adult hip for treatment of hip arthritis.
Healthcare Provider Taxonomy #1
Provider License Number 1 ME144788
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 FL
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.