TIERRA ELONDA BLACKMON
NPI 1003261363
Nurse Practitioner - Family in Dallas, TX

Q: What is Tierra Blackmon's NPI number?

The NPI number for Tierra Blackmon is 1003261363. It was assigned to this individual provider in the NPPES registry on April 24, 2016.

Q: What is Tierra Blackmon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Tierra Blackmon was last updated on November 13, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 24, 2016PECOS EnrolledAccepts Medicare Assignment

5323 HARRY HINES BLVD, DALLAS, TX 75390(214) 633-5555 Get Directions Write a Review

NPPES record last updated: November 13, 2019. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 13, 2019, Oct 8, 2018, Oct 25, 2016 (3 updates tracked since 2016).

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About Tierra Elonda Blackmon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIERRA ELONDA BLACKMON (NPI 1003261363) is an individual family provider in Dallas, Texas, licensed in Texas (AP132292) and active in the NPI registry since April 2016. She is enrolled in Medicare PECOS, is affiliated with St Dominic-jackson Memorial Hospital, and maintains a secondary practice location in Irving.

NPPES Registry Identity

NPI1003261363

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameTIERRA ELONDA BLACKMON

Location Address5323 HARRY HINES BLVDDallas, TX 75390-7208

Mailing AddressPo Box 845347Dallas, TX 75248-7208

Phone(214) 633-5555

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateApril 24, 2016

Last NPPES UpdateNovember 13, 20193 updates tracked since enumeration

✔ NPI 1003261363 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in TX · AP132292

Also ListedNurse PractitionerTaxonomy 363L00000X · License 901816 (MS)

5323 HARRY HINES BLVD, Dallas, TX 75390

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Secondary Practice Location 1

Location 17447 N MacArthur BlvdIrving, TX 75063-7509 · Phone (469) 249-9649

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tierra Elonda Blackmon is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618245895

PECOS Enrollment IDI20241112002784, I20260401003147

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

25 services25 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Dominic-Jackson Memorial Hospital

Acute Care Hospitals · Jackson, MS

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number250048

Location969 Lakeland DrJackson, MS 39216 · Hinds County

Emergency services Birthing friendly

Och Regional Medical Center

Acute Care Hospitals · Starkville, MS

2/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number250050

Location400 Hospital Road /Mail PO Box 1506Starkville, MS 39759 · Oktibbeha County

Emergency services Birthing friendly

Clay County Medical Corporation

Acute Care Hospitals · West Point, MS

OwnershipVoluntary non-profit - Private

CMS Certification Number250067

Location150 Medical Center DriveWest Point, MS 39773 · Clay County

Emergency services Birthing friendly

Pontotoc Health Service Inc Cah

Critical Access Hospitals · Pontotoc, MS

OwnershipVoluntary non-profit - Private

CMS Certification Number251308

Location176 South Main StreetPontotoc, MS 38863 · Pontotoc County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75390 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.19 typical visit price

range $57.18 – $172.86

Typical copayment $22.04 (range $14.29 – $43.21)

Most-billed visit code 99203

Established Patient

$100.80 typical visit price

range $18.48 – $141.20

Typical copayment $25.20 (range $4.62 – $35.30)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEVIN GINGRICH M.D.

Anesthesiology