Physician Compare National (NPI:1124254586)

HEALTHCARE PROVIDER: CHERI A BLACKSTEN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1124254586
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486952967
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160418000113
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLACKSTEN
	Individual professional last name
Provider First Name	CHERI
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8202 LOUISIANA BLVD NE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	ALBUQUERQUE
	Group Practice or individual's city
State	NM
	Group Practice or individual's state
Zip Code	871132103
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	320021
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PRESBYTERIAN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y