DR. JACK THOMAS JR. BLACKWELL (MD) – Anesthesiology Physician, NPI 1356332100
Anesthesiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,330 ANESTHESIOLOGY in GA
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Provider Addresses for DR. JACK THOMAS JR. BLACKWELL (MD)
East Georgia Regional Medical Center, 1499, Fair Road, Somerset, Statesboro, Bulloch County, Georgia, 30458, United States of America
STATESBORO, GA 304581683
Phone: (912) 486-1482
Fax: (912) 871-2383
Type: Mailing
Eisenhower Drive, Brookview, Savannah, Chatham County, Georgia, 31406, United States
STE 6
SAVANNAH, GA 314062600
Phone: (912) 354-3510
Fax: (912) 356-3391
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2006-10-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20061030000149 | I | Anesthesiology | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30458)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| ANESTHESIOLOGY | GA | 00142 | Anesthesia for lens surgery | 44 | 43 |
| ANESTHESIOLOGY | GA | 00790 | Anesthesia for procedure in upper abdomen including use of an endoscope | 36 | 36 |
| ANESTHESIOLOGY | GA | 01402 | Anesthesia for open or endoscopic total knee joint replacement | 17 | 17 |
| ANESTHESIOLOGY | GA | 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 12 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| Certified Registered Nurse Anesthetist (Crna) | GA | |
| - | GA | |
| Certified Registered Nurse Anesthetist (Crna) | GA | |
| Certified Registered Nurse Anesthetist (Crna) | GA | |
| A N E S T H E S I O L O G Y | GA | |
| - | GA | |
| A N E S T H E S I O L O G Y | FL | |
| Anesthesiology Assistant | FL | |
| Certified Registered Nurse Anesthetist (Crna) | GA |
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