DR. SHEM KEARNEY BLACKLEY IV MD
NPI 1649857202
Surgery in Winston Salem, NC

Q: What is Shem Blackley's NPI number?

The NPI number for Shem Blackley is 1649857202. It was assigned to this individual provider in the NPPES registry on March 28, 2021.

Q: What is Shem Blackley's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Shem Blackley was last updated on June 19, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 28, 2021PECOS Enrolled

1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157(336) 713-4211(336) 716-9758 Get Directions Write a Review

NPPES record last updated: June 19, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 10, 2023, Mar 28, 2021 (2 updates tracked since 2021).

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About Dr. Shem Kearney Blackley Iv Md NPPES

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

DR. SHEM KEARNEY BLACKLEY IV MD (NPI 1649857202) is an individual surgery provider in Winston Salem, North Carolina, licensed in North Carolina (2026-02846) and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS and is a graduate of Wake Forest University School Of Medicine (2021).

NPPES Registry Identity

NPI1649857202

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameDR. SHEM KEARNEY BLACKLEY IVCredential: MD

Location Address1 MEDICAL CENTER BLVDWinston Salem, NC 27157-0001

Mailing Address1 Medical Center BlvdWinston Salem, NC 27157-0001 · (336) 713-4211 · Fax (336) 716-9758

Phone(336) 713-4211

Fax(336) 716-9758

Sole ProprietorNo

Medical School CMSWake Forest University School Of MedicineGraduated 2021

Enumeration DateMarch 28, 2021

Last NPPES UpdateJune 19, 20262 updates tracked since enumeration

NPPES CertifiedJune 19, 2026

✔ NPI 1649857202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

Licenses✔ Licensed in NC · 2026-02846✔ Licensed in AL · MD.45368

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

1 MEDICAL CENTER BLVD, Winston Salem, NC 27157

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shem Kearney Blackley Iv Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID840694147

PECOS Enrollment IDI20260604003586

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 27157 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

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

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.