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ANNA BLACKSHARE
NPI 1477202083
Student in an Organized Health Care Education/Training Program in Little Rock, AR

Active since March 21, 2022PECOS Enrolled
905 N TAYLOR ST, LITTLE ROCK, AR 72205(870) 595-4295 Get Directions Write a Review

NPPES record last updated: March 21, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Anna Blackshare NPPES

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

ANNA BLACKSHARE (NPI 1477202083) is an individual student in an organized health care education/training program in Little Rock, Arkansas and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS and is a graduate of University Of Arkansas College Of Medicine (2022).

NPPES Registry Identity

NPI1477202083
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameANNA BLACKSHARE
Location Address905 N TAYLOR STLittle Rock, AR 72205-1742
Mailing Address905 N Taylor StLittle Rock, AR 72205-1742 · (870) 595-4295
Phone(870) 595-4295
Sole ProprietorNo
Medical School CMSUniversity Of Arkansas College Of MedicineGraduated 2022
Enumeration DateMarch 21, 2022
NPPES CertifiedMarch 21, 2022
✔ NPI 1477202083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
905 N TAYLOR ST, Little Rock, AR 72205
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Anna Blackshare is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9830571611
PECOS Enrollment IDI20260819004225
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.

Medicare Billing Reassignment

Medicare enrollment records show Anna Blackshare reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Ssm Medical Group, Inc.
280 mi
Multi-Specialty
1011 BOWLES AVE, SUITE 300
Fenton, MO 63026
  • Reassigned Medicare billing, Missouri enrollment
  • 697 clinicians in this Medicare group
NPI 1700966207 (636) 496-5000

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

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 Anna Blackshare's NPI number?

The NPI number for Anna Blackshare is 1477202083. It was assigned to this individual provider in the NPPES registry on March 21, 2022.

Where is Anna Blackshare located?

Anna Blackshare practices at 905 N Taylor St, Little Rock, AR 72205. The listed phone number is (870) 595-4295.

What is Anna Blackshare's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Anna Blackshare enrolled in Medicare?

Yes. Anna Blackshare is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Anna Blackshare's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Anna Blackshare reassigns Medicare benefits to Ssm Medical Group, Inc. (Fenton, MO). The 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 Anna Blackshare's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Anna Blackshare was last updated on March 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.