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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

KALOB MICHAEL BLACKWELL PA-C
NPI 1710805973
Physician Assistant in Shawnee, OK

Active since July 07, 2026PECOS Enrolled
4409 N KICKAPOO AVE, SHAWNEE, OK 74804(405) 242-4100 Get Directions Write a Review

NPPES record last updated: October 1, 2026. Verified against the NPPES registry weekly; last sync: October 11, 2026.

Record update history: Oct 1, 2026, Jul 9, 2026 (2 updates tracked since 2026).

About Kalob Michael Blackwell Pa-c NPPES

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

KALOB MICHAEL BLACKWELL PA-C (NPI 1710805973) is an individual physician assistant in Shawnee, Oklahoma, licensed in Oklahoma (6206) and active in the NPI registry since July 2026. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2026).

NPPES Registry Identity

NPI1710805973
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameKALOB MICHAEL BLACKWELLCredential: PA-C
Location Address4409 N KICKAPOO AVEShawnee, OK 74804-1206
Mailing AddressPo Box 108835Oklahoma City, OK 73101-8835 · (405) 242-4100 · Fax (405) 775-9356
Phone(405) 242-4100
Sole ProprietorNo
Medical School CMSOtherGraduated 2026
Enumeration DateJuly 7, 2026
Last NPPES UpdateOctober 1, 20262 updates tracked since enumeration
NPPES CertifiedOctober 1, 2026
✔ NPI 1710805973 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 OK · 6206
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.
4409 N KICKAPOO AVE, Shawnee, OK 74804
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Secondary Practice Locations 3

Location 11703 Professional Cir Ste 101Yukon, OK 73099-6497 · Phone (405) 242-4100 · Fax (405) 775-9356
Location 23601 NW 138th St Ste 200Oklahoma City, OK 73134-2513 · Phone (405) 242-4100 · Fax (405) 775-9356
Location 34023 N Flood AveNorman, OK 73069-8354 · Phone (405) 242-4100 · Fax (405) 775-9356

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kalob Michael Blackwell Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9739646167
PECOS Enrollment IDI20260805004804
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 74804 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
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$66.48 typical visit price
range $16.68 – $132.40
Typical copayment $16.62 (range $4.17 – $33.10)
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.

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.

KELLI ANNE-MARIE SULLIVAN
Nurse Practitioner (Family)
4409 N KICKAPOO AVE
SHAWNEE, OK 74804
Pottawatomie County (405) 242-4100
NKR ENTERPRISES, APRN-CNP, PLLC
Nurse Practitioner (Family)
4409 N KICKAPOO AVE, SUITE 121
SHAWNEE, OK 74804
Pottawatomie County (405) 249-0459
OCEAN DENTAL, PC
Dentist (General Practice)
4409 N KICKAPOO AVE
SHAWNEE, OK 74804
Pottawatomie County (405) 273-7077
GKW - OPM LLC
Pain Medicine (Interventional Pain Medicine)
4409 N KICKAPOO AVE
SHAWNEE, OK 74804
Pottawatomie County (405) 242-4100

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 Kalob Blackwell's NPI number?

The NPI number for Kalob Blackwell is 1710805973. It was assigned to this individual provider in the NPPES registry on July 7, 2026.

Where is Kalob Blackwell located?

Kalob Blackwell practices at 4409 N Kickapoo Ave, Shawnee, OK 74804. The listed phone number is (405) 242-4100.

What is Kalob Blackwell's specialty?

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

Is Kalob Blackwell enrolled in Medicare?

Yes. Kalob Blackwell is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kalob Blackwell was last updated on October 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 days 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.