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BLACKSBURG WELLNESS CENTER, LLC
NPI 1144176512
Internal Medicine in Blacksburg, VA

Active since March 09, 2026CLIA 49D2345052 · Waiver
105 MCDONALD ST, BLACKSBURG, VA 24060(540) 552-5545(540) 552-5568 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Blacksburg Wellness Center, Llc NPPES

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

BLACKSBURG WELLNESS CENTER, LLC (NPI 1144176512) is a healthcare organization registered as an internal medicine in Blacksburg, Virginia and active in the NPI registry since March 2026. The organization holds a CLIA Waiver certificate valid through June 3, 2028 and lists Mary-ellen Mick, Physician, as its authorized official.

NPPES Registry Identity

NPI1144176512
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBLACKSBURG WELLNESS CENTER, LLC
Location Address105 MCDONALD STBlacksburg, VA 24060-3420
Mailing Address105 Mcdonald StBlacksburg, VA 24060-3420 · (540) 552-5545 · Fax (540) 552-5568
Phone(540) 552-5545
Fax(540) 552-5568
Organization SubpartNo
Authorized OfficialMary-ellen MickPhysician · (540) 552-5545
Enumeration DateMarch 9, 2026
NPPES CertifiedMarch 9, 2026
✔ NPI 1144176512 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
105 MCDONALD ST, Blacksburg, VA 24060
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blacksburg Wellness Center, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Blacksburg Wellness Center, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Mary Ellen Mick, D.O.
Internal Medicine
NPI 1124339924
105 MCDONALD ST
Blacksburg, VA 24060
(540) 552-5545
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2345052

Blacksburg Wellness Center, LLC · Blacksburg, VA
Active · expires Jun 3, 2028
CLIA Number49D2345052
Laboratory TypePhysician Office
Certificate Effective DateJune 4, 2026
Certificate Expiration DateJune 3, 2028
Laboratory DirectorMary Ellen C. Mick
Laboratory Phone(540) 552-5545
Laboratory LocationBlacksburg Wellness Center, LLC105 Mcdonald Street, Blacksburg, VA 24060
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Blacksburg Wellness Center, LLC's NPI number?

The NPI number for Blacksburg Wellness Center, LLC is 1144176512. It was assigned to this organization in the NPPES registry on March 9, 2026.

Where is Blacksburg Wellness Center, LLC located?

Blacksburg Wellness Center, LLC is located at 105 Mcdonald St, Blacksburg, VA 24060. The listed phone number is (540) 552-5545.

What is Blacksburg Wellness Center, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Blacksburg Wellness Center, LLC enrolled in Medicare?

Yes. Blacksburg Wellness Center, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Blacksburg Wellness Center, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Blacksburg Wellness Center, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Blacksburg Wellness Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2345052) is associated with this NPI, valid through June 3, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Blacksburg Wellness Center, LLC was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.