Gladys Blackburn, NP in South Bend, IN - Medicare Nurse Practitioner

Gladys Blackburn, NP is a medicare enrolled "Nurse Practitioner - Family" in South Bend, Indiana. Her current practice location is 1901 W Western Ave Ste B, South Bend, Indiana. You can reach out to her office (for appointments etc.) via phone at (574) 234-9033.

Gladys Blackburn is licensed to practice in Indiana (license number 71010379A) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1861005589.

Contact Information

	Gladys Blackburn, NP
	1901 W Western Ave Ste B, South Bend, IN 46619-3570
	(574) 234-9033
	Not Available

Map and Direction

Provider's Profile

Full Name	Gladys Blackburn
Gender	Female
Speciality	Nurse Practitioner - Family
Location	1901 W Western Ave Ste B, South Bend, Indiana
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1861005589
Provider Enumeration Date: 08/24/2020
Last Update Date: 05/09/2024

Medicare PECOS Information:

PECOS PAC ID: 0941620025
Enrollment ID: I20201009002407

Medical Identifiers

Medical identifiers for Gladys Blackburn such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1861005589	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	28222639A (Indiana)	Secondary
363LF0000X	Nurse Practitioner - Family	71010379A (Indiana)	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. Gladys Blackburn allows following entities to bill medicare on her behalf.

Entity Name	Dukes Physician Services Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1255396883 PECOS PAC ID: 3375508211 Enrollment ID: O20041119000956

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. Gladys 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
Gladys Blackburn, NP 285 W 12th St Ste 206, Peru, IN 46970-1654 Ph: (765) 472-5335	Gladys Blackburn, NP 1901 W Western Ave Ste B, South Bend, IN 46619-3570 Ph: (574) 234-9033

Reviews and Comments

Nurse Practitioner Nurses in South Bend, IN

Beth Ann Hayden, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 707 N Michigan St, Ste 400, South Bend, IN 46601 Phone: 574-647-8470 Fax: 574-647-8475
Rachel Ann Jennings, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 615 N Michigan St, South Bend, IN 46601 Phone: 574-647-1000
Kelly Mae Losiniecki, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 211 N Eddy St., South Bend, IN 46617 Phone: 574-237-9231 Fax: 574-204-6355
Mrs. Brandice Lynn Page, APNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 53760 Generations Dr, South Bend, IN 46635 Phone: 888-938-3838 Fax: 888-919-1083
Gina M. Connolly, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 100 Navarre Pl Ste 6600, South Bend, IN 46601 Phone: 574-647-8800 Fax: 574-647-8811
Amanda Lundberg, MSN, RN, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 53830 Generations Dr Ste 110, South Bend, IN 46635 Phone: 574-234-2191
Kendall Hochstedler, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1960 Northside Blvd, South Bend, IN 46615 Phone: 574-307-7673 Fax: 574-234-4706

Gladys Blackburn, NP - Medicare Nurse Practitioner in South Bend, IN