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KIZUWANDA BLACKBURNE RPAC
NPI 1417020405
Physician Assistant in Stockbridge, GA

Active since November 16, 2006PECOS EnrolledAccepts Medicare Assignment
92.26/100
CMS Quality Rating
145 EAGLES WALK, SUITE A, STOCKBRIDGE, GA 30281(770) 389-3855(770) 474-8078 Get Directions Write a Review

NPPES record last updated: April 1, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kizuwanda Blackburne Rpac NPPES

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

KIZUWANDA BLACKBURNE RPAC (NPI 1417020405) is an individual physician assistant in Stockbridge, Georgia, licensed in Georgia (5126) and active in the NPI registry since November 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2004).

NPPES Registry Identity

NPI1417020405
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKIZUWANDA BLACKBURNECredential: RPAC
Location Address145 EAGLES WALK, SUITE AStockbridge, GA 30281-7340
Mailing Address145 Eagles Walk, Suite AStockbridge, GA 30281-7340 · (770) 389-3855 · Fax (770) 474-8078
Phone(770) 389-3855
Fax(770) 474-8078
Sole ProprietorNo
Medical School CMSOtherGraduated 2004
Enumeration DateNovember 16, 2006
Last NPPES UpdateApril 1, 2008
✔ NPI 1417020405 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 GA · 5126
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.
145 EAGLES WALK, Stockbridge, GA 30281
Open in Google Maps ↗

Other Identifiers 1

Other061407GA · Bcbs Of Ga Group #

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

Kizuwanda Blackburne Rpac 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 ID3072531821
PECOS Enrollment IDI20080515000614
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.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
46 services42 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
33 services29 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
17 services16 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30281 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
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$70.85 typical visit price
range $18.22 – $140.40
Typical copayment $17.71 (range $4.55 – $35.10)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.26/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality73.83
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 2

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

SHARON WILLIAMS FNP-C
Nurse Practitioner (Family)
145 EAGLES WALK, SUITE A
STOCKBRIDGE, GA 30281
Henry County (770) 389-3855
MS. SHANNON LARISSA COX PA-C
Physician Assistant (Medical)
145 EAGLES WALK, SUITE A
STOCKBRIDGE, GA 30281
Henry County (770) 389-3855

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 Kizuwanda Blackburne's NPI number?

The NPI number for Kizuwanda Blackburne is 1417020405. It was assigned to this individual provider in the NPPES registry on November 16, 2006.

Where is Kizuwanda Blackburne located?

Kizuwanda Blackburne practices at 145 Eagles Walk Suite A, Stockbridge, GA 30281. The listed phone number is (770) 389-3855.

What is Kizuwanda Blackburne's specialty?

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

Is Kizuwanda Blackburne enrolled in Medicare?

Yes. Kizuwanda Blackburne is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kizuwanda Blackburne was last updated on April 1, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.