TINA MARIE BLACKLEY APRN FNP-C
NPI 1962937417
Nurse Practitioner - Family in Bangor, ME
About Tina Marie Blackley Aprn Fnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TINA MARIE BLACKLEY APRN FNP-C (NPI 1962937417) is an individual family provider in Bangor, Maine, licensed in Maine (CNP171038) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS, is affiliated with Northern Light Eastern Maine Medical Center, and is a graduate of Other (2017).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Tina Marie Blackley Aprn Fnp-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.
Medicare Billing Reassignment
Medicare enrollment records show Tina Blackley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Indian Island, ME 04468
- Reassigned Medicare billing, Texas enrollment
- 5 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Northern Light Eastern Maine Medical Center
Acute Care Hospitals · Bangor, MEPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 04401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
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 Tina Blackley's NPI number?
The NPI number for Tina Blackley is 1962937417. It was assigned to this individual provider in the NPPES registry on April 21, 2017.
Where is Tina Blackley located?
Tina Blackley practices at 900 Broadway, Bangor, ME 04401. The listed phone number is (207) 907-3300.
What is Tina Blackley's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Tina Blackley enrolled in Medicare?
Yes. Tina Blackley 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.
Which organization bills Medicare for Tina Blackley's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tina Blackley reassigns Medicare benefits to Penobscot Indian Nation Finance Office (Indian Island, ME). 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 Tina Blackley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Tina Blackley accept?
Health plans from Anthem Blue Cross and Blue Shield list Tina Blackley as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Tina Blackley affiliated with any hospitals?
According to CMS data, Tina Blackley is affiliated with Northern Light Eastern Maine Medical Center.
When was this NPI record last updated?
The NPPES record for Tina Blackley was last updated on December 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Tina Marie Blackley, APRN FNP-C · NPI 1962937417
Family physician in Bangor, Maine. Individual provider, active in the CMS NPPES registry since April 21, 2017.
## Identity
- **NPI:** 1962937417 (Entity type: Individual)
- **Enumerated:** April 21, 2017
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** CNP171038 (Maine)
- **Sole proprietor:** No
## Practice location
- **Address:** 900 BROADWAY, Bangor, ME 04401
- **Phone:** (207) 907-3300 · **Fax:** (207) 907-1923
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Penobscot Indian Nation Finance Office (NPI 1639139140, Indian Island, ME), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2017
## Record status
- **NPPES last updated:** December 6, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1962937417) · Data from the CMS NPPES public registry.