1. Home
  2. Directory
  3. Arkansas
  4. Pine Bluff
  5. Nurse Practitioner
  6. NPI Profile

JO BLASENGAME AGACNP-BC
NPI 1356005250
Nurse Practitioner in Pine Bluff, AR

Active since October 26, 2021PECOS Enrolled
1609 W 40TH AVE STE 205, PINE BLUFF, AR 71603(870) 541-7211 Get Directions Write a Review

NPPES record last updated: January 27, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jo Blasengame Agacnp-bc NPPES

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

JO BLASENGAME AGACNP-BC (NPI 1356005250) is an individual nurse practitioner in Pine Bluff, Arkansas, licensed in Arkansas (217776) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1356005250
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameJO BLASENGAMECredential: AGACNP-BC
Location Address1609 W 40TH AVE STE 205Pine Bluff, AR 71603-6367
Mailing AddressPo Box 2650Pine Bluff, AR 71613-2650 · (870) 541-7211
Phone(870) 541-7211
Sole ProprietorYes
Enumeration DateOctober 26, 2021
Last NPPES UpdateJanuary 27, 2023
NPPES CertifiedJanuary 27, 2023
✔ NPI 1356005250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in AR · 217776
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 217776 (AR)
1609 W 40TH AVE STE 205, Pine Bluff, AR 71603
Open in Google Maps ↗

Secondary Practice Locations 3

Location 12894 Autumn Hills RdStar City, AR 71667-9554 · Phone (870) 628-3842
Location 24310 S Mulberry StPine Bluff, AR 71603-7030 · Phone (870) 541-7211
Location 31609 W 40th Ave Ste 111Pine Bluff, AR 71603-6319 · Phone (870) 541-7211

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jo Blasengame Agacnp-bc 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 71603 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
$79.72 typical visit price
range $51.36 – $157.74
Typical copayment $19.93 (range $12.84 – $39.43)
Most-billed visit code 99203
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
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 4

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

BRIAN CAMPBELL JIMENEZ M.D.
Internal Medicine (Hematology & Oncology)
1609 W 40TH AVE STE 205
PINE BLUFF, AR 71603
Jefferson County (870) 541-3230
JEFFERSON REGIONAL CANCER CENTER
Clinic/Center (Oncology)
1609 W 40TH AVE STE 205
PINE BLUFF, AR 71603
Jefferson County (870) 534-1188
ASIF MASOOD M.D.
Internal Medicine (Hematology & Oncology)
1609 W 40TH AVE STE 205
PINE BLUFF, AR 71603
Jefferson County (870) 534-1188
MELISSA CAROL KOONCE APRN
Nurse Practitioner
1609 W 40TH AVE STE 205
PINE BLUFF, AR 71603
Jefferson County (870) 534-1188

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 Jo Blasengame's NPI number?

The NPI number for Jo Blasengame is 1356005250. It was assigned to this individual provider in the NPPES registry on October 26, 2021.

Where is Jo Blasengame located?

Jo Blasengame practices at 1609 W 40th Ave Ste 205, Pine Bluff, AR 71603. The listed phone number is (870) 541-7211.

What is Jo Blasengame's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Jo Blasengame enrolled in Medicare?

Yes. Jo Blasengame is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jo Blasengame was last updated on January 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.