Dr Jay H Blackburn, DDS is a medicare enrolled "Dentist - General Practice" provider in New Buffalo, Michigan. His current practice location is
105 W. Merchant Street, New Buffalo, Michigan. You can reach out to his office (for appointments etc.) via phone at
(269) 469-3140.
Dr Jay H Blackburn is licensed to practice in Michigan (license number 13579) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1730103045.
Healthcare Provider's Profile
| Full Name | Dr Jay H Blackburn |
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| Gender | Male |
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| Speciality | Dentist - General Practice |
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| Location | 105 W. Merchant Street, New Buffalo, Michigan |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1730103045
- Provider Enumeration Date: 07/27/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 4385887207
- Enrollment ID: I20130826000164
Medical Identifiers
Medical identifiers for Dr Jay H Blackburn such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1730103045 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223G0001X | Dentist - General Practice | 13579 (Michigan) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jay H Blackburn allows following entities to bill medicare on his behalf.
| Entity Name | Intercare Community Health Network |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1326058512
PECOS PAC ID: 9537061254
Enrollment ID: O20040223000150 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jay H Blackburn is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Jay H Blackburn, DDS
105 W. Merchant Street,
New Buffalo, MI 49117-1813
Ph: (269) 469-3140 | Dr Jay H Blackburn, DDS
105 W. Merchant Street,
New Buffalo, MI 49117-1813
Ph: (269) 469-3140 |
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