MICHAELA ROSE BLACKWELL PA-C
NPI 1407553019
Physician Assistant in Rockford, IL

Q: What is Michaela Blackwell's NPI number?

The NPI number for Michaela Blackwell is 1407553019. It was assigned to this individual provider in the NPPES registry on February 14, 2023.

Q: What is Michaela Blackwell's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Active since February 14, 2023PECOS EnrolledAccepts Medicare Assignment

5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114(815) 398-9491 Get Directions Write a Review

NPPES record last updated: November 1, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 18, 2023, Feb 14, 2023 (2 updates tracked since 2023).

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About Michaela Rose Blackwell Pa-c NPPES

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

MICHAELA ROSE BLACKWELL PA-C (NPI 1407553019) is an individual physician assistant in Rockford, Illinois, licensed in Illinois (085010688) and active in the NPI registry since February 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1407553019

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMICHAELA ROSE BLACKWELLCredential: PA-C

Location Address5875 E RIVERSIDE BLVDRockford, IL 61114-4937

Mailing AddressPo Box 735263Chicago, IL 60673-5263

Phone(815) 398-9491

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateFebruary 14, 2023

Last NPPES UpdateNovember 1, 20242 updates tracked since enumeration

NPPES CertifiedNovember 1, 2024

✔ NPI 1407553019 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IL · 085010688

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

5875 E RIVERSIDE BLVD, Rockford, IL 61114

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

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

Michaela Rose Blackwell Pa-c 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 ID5395191381

PECOS Enrollment IDI20241108002879

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 61114 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

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.

DR. LIZA A DAFCHAHI SHIRANI MD

Anesthesiology