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CARLY JEAN BLASINGAME CPNP-PC
NPI 1104504984
Nurse Practitioner - Primary Care in Fort Worth, TX

Active since July 10, 2023PECOS Enrolled
1500 COOPER ST, FORT WORTH, TX 76104(682) 885-2500(682) 885-2510 Get Directions Write a Review

NPPES record last updated: April 6, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Apr 6, 2026, Jul 16, 2024, Jul 19, 2023 and 1 more (4 updates tracked since 2023).

About Carly Jean Blasingame Cpnp-pc NPPES

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

CARLY JEAN BLASINGAME CPNP-PC (NPI 1104504984) is an individual primary care provider in Fort Worth, Texas, licensed in Texas (1127441) and active in the NPI registry since July 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104504984
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameCARLY JEAN BLASINGAMECredential: CPNP-PC
Location Address1500 COOPER STFort Worth, TX 76104-2710
Mailing AddressPo Box 733784Dallas, TX 75373-3784 · (682) 885-6483 · Fax (682) 885-3113
Phone(682) 885-2500
Fax(682) 885-2510
Sole ProprietorNo
Enumeration DateJuly 10, 2023
Last NPPES UpdateApril 6, 20264 updates tracked since enumeration
NPPES CertifiedApril 6, 2026
✔ NPI 1104504984 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in TX · 1127441
Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X · License 1127441 (TX)
1500 COOPER ST, Fort Worth, TX 76104
Open in Google Maps ↗

Other Names 1

Former Name (1)Carly Jean Shelby

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Imperial Insurance Companies, Inc..Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Carly Jean Blasingame Cpnp-pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76104 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
$87.20 typical visit price
range $56.47 – $171.07
Typical copayment $21.80 (range $14.11 – $42.76)
Most-billed visit code 99203
Established Patient
$99.68 typical visit price
range $18.18 – $139.68
Typical copayment $24.92 (range $4.54 – $34.92)
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.

KATRINA L WILLIE-MUSOMA MD
Pediatrics (Neurodevelopmental Disabilities)
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 303-9300
SCHARLYN R HENDERSON LCSW
Social Worker (Clinical)
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-1475
GREGORY BARKER
Pediatrics (Pediatric Cardiology)
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-2140
DR. ELORA PATTANAIK CORBIN M.D.
Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-2500
SHANE KELLEHER PA-C
Physician Assistant
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-7840
BENJAMIN CRAIG PA-C
Physician Assistant
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-2500
DR. SHAILENDRA DAS D.O.
Pediatrics (Pediatric Pulmonology)
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-6299
JAMES C CUNNINGHAM MD
Pediatrics (Pediatric Pulmonology)
1500 COOPER ST
FORT WORTH, TX 76104
Tarrant County (682) 885-6299

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 Carly Blasingame's NPI number?

The NPI number for Carly Blasingame is 1104504984. It was assigned to this individual provider in the NPPES registry on July 10, 2023. The provider is also known as Carly Jean Shelby.

Where is Carly Blasingame located?

Carly Blasingame practices at 1500 Cooper St, Fort Worth, TX 76104. The listed phone number is (682) 885-2500.

What is Carly Blasingame's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Carly Blasingame enrolled in Medicare?

Yes. Carly Blasingame is registered in the Medicare PECOS enrollment system.

What insurance does Carly Blasingame accept?

Health plans from Blue Cross and Blue Shield of Texas and Imperial Insurance Companies, Inc. list Carly Blasingame as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Carly Blasingame was last updated on April 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.