Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1285990291 Deactivated / Inactive NPI Male Practitioner

Dr. John P. Blackburn , MD

Contractor • Bowling Green, KY

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. John Blackburn has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 03, 2012
NPI Deactivation Date November 29, 2017
Total Practice Duration ~5 Years of Practice (2012 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. John Blackburn, MD was a registered Contractor practicing in Bowling Green, KY. Throughout an active medical career spanning 5 years, Dr. Blackburn provided care at the practice location at 1225 FAIRWAY ST until profile deactivation on 2017-11-29.

Practice Location & Contact Primary Location

Practice Address

1225 Fairway St

Bowling Green, KY 421032477

Telephone 2707451517
Associated Practice Facility / Clinic
🏢 Park Street Partners, L.l.p. Facility NPI 1053341339

Specialty Benchmarks & Practice Insights

Comparative analytics for Contractor in Bowling Green, KY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
4 Specialists

Practicing in Bowling Green, KY (86 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Contractor Primary Specialty

NUCC Taxonomy Code: 171W00000X

State License KY 14227

A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering).

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Dr. Medhat Grace , MD

Family Medicine

NPI 1083608566

Doctor of Medicine (M.D.)

Rainatou Salifu , APRN

Nurse Practitioner - Family

NPI 1124794953

Advanced Practice Registered Nurse

Stephanie Steff , APRN

Nurse Practitioner

NPI 1194178970

Advanced Practice Registered Nurse

Valeriya Barko , APRN

Nurse Practitioner - Family

NPI 1275898306

Advanced Practice Registered Nurse

Sana Ali , APRN

Nurse Practitioner - Family

NPI 1396238408

Advanced Practice Registered Nurse

Dr. Wayne Hendrix , MD

Internal Medicine

NPI 1447254206

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated November 29, 2017

Record deactivated on November 29, 2017

NPI Profile Active April 03, 2012

NPI status registered as active in NPPES database

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Updated Practice Location April 03, 2012

Registered at 1225 FAIRWAY ST, BOWLING GREEN, KY 421032477 (Tel: 2707451517)

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Updated Business Mailing Address April 03, 2012

Registered at 1225 FAIRWAY ST, BOWLING GREEN, KY 421032477 (Tel: 2707451517)

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Provider Name / Credentials Updated April 03, 2012

Recorded as JOHN BLACKBURN, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 03, 2012

Contractor (License #14227 in KY)

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Initial NPI Registration & Enumeration April 03, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1285990291
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 03, 2012
Last Update: April 03, 2012
Deactivation Date: November 29, 2017

Mailing Address

1225 Fairway St

Bowling Green, KY 421032477

Phone: 2707451517

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.