CLINTON JED BLAINE (P.A.) – Physician Assistant, NPI 1558340844
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,131 EMERGENCY MEDICINE in TN
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Provider Addresses for CLINTON JED BLAINE (P.A.)
Rice Box, Atlanta BeltLine Eastside Trail, Atlanta, Fulton County, Georgia, 30308, United States
ATLANTA, GA 303845800
Phone: (901) 227-3255
Fax: (901) 227-8591
Type: Mailing
Poplar Avenue, Poplar Plaza, Chickasaw Gardens, Memphis, Shelby County, West Tennessee, Tennessee, 38152, United States
MEMPHIS, TN 381114690
Phone: (901) 327-8713
Fax: (901) 327-8284
Type: Location
3500 PURDY RD
HUNTINGDON, TN 383448050
Phone: (541) 731-4672
Type: Mailing
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: 2026-01-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20040624000850 | I | Physician Assistant | TN | TBD |
| I20260116000104 | I | Emergency Medicine | VA | 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 30384)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | TN | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 13 | 13 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | NC | |
| Nurse Practitioner | KY | |
| - | NC | |
| Nurse Practitioner | VA | |
| Nurse Practitioner | VA | |
| - | VA | |
| Nurse Practitioner | VA | |
| Nurse Practitioner | VA | |
| Family Practice | NC | |
| Nurse Practitioner | NC |
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