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JACOB BLACKMON CCP
NPI 1053130930
Perfusionist in Plymouth, MI

Active since October 07, 2024
45211 HELM ST., PLYMOUTH, MI 48170(480) 777-0900(480) 777-1345 Get Directions Write a Review

NPPES record last updated: June 26, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jacob Blackmon Ccp NPPES

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

JACOB BLACKMON CCP (NPI 1053130930) is an individual perfusionist provider in Plymouth, Michigan, licensed in Texas (199052) and active in the NPI registry since October 2024.

NPPES Registry Identity

NPI1053130930
Entity TypeIndividualMale
Primary Taxonomy242T00000X
Provider Legal NameJACOB BLACKMONCredential: CCP
Location Address45211 HELM ST.Plymouth, MI 48170
Mailing Address45211 Helm St.Plymouth, MI 48170 · (480) 777-0900 · Fax (480) 777-1345
Phone(480) 777-0900
Fax(480) 777-1345
Sole ProprietorNo
Enumeration DateOctober 7, 2024
Last NPPES UpdateJune 26, 2026
NPPES CertifiedJune 26, 2026
✔ NPI 1053130930 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPerfusionistTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code242T00000X
License✔ Licensed in TX · 199052
Definition
A perfusionist operates extracorporeal circulation and autotransfusion equipment during any medical situation where it is necessary to support or temporarily replace the patient's circulatory or respiratory function. The perfusionist is knowledgeable concerning the variety of equipment available to perform extracorporeal circulation functions and is responsible, in consultation with the physician, for selecting the appropriate equipment and techniques to be used.
45211 HELM ST., Plymouth, MI 48170
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Other Providers at the Same Location NPPES 6

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

LAUREN NICHOLSON
Perfusionist
45211 HELM ST.
PLYMOUTH, MI 48170
Wayne County (480) 777-0900
DAVID EVANS
Perfusionist
45211 HELM ST.
PLYMOUTH, MI 48170
Wayne County (148) 077-7060
CHRISTOPHER WILDE CCP
Perfusionist
45211 HELM ST.
PLYMOUTH, MI 48170
Wayne County (480) 777-0900
COURTNEY A. BASS
Perfusionist
45211 HELM ST.
PLYMOUTH, MI 48170
Wayne County (734) 525-9712
ALLISON C PERANTONI
Perfusionist
45211 HELM ST.
PLYMOUTH, MI 48170
Wayne County (480) 777-0900
PAULLA MASSIE C.C.P.
Perfusionist
45211 HELM ST.
PLYMOUTH, MI 48170
Wayne County (480) 777-0900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Blackmon's NPI number?

The NPI number for Jacob Blackmon is 1053130930. It was assigned to this individual provider in the NPPES registry on October 7, 2024.

Where is Jacob Blackmon located?

Jacob Blackmon practices at 45211 Helm St., Plymouth, MI 48170. The listed phone number is (480) 777-0900.

What is Jacob Blackmon's specialty?

The primary specialty registered for this NPI is Perfusionist with taxonomy code 242T00000X.

When was this NPI record last updated?

The NPPES record for Jacob Blackmon was last updated on June 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 40 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.