Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michaela Rose Blackwell, PA-C

Individual provider Physician Assistant · NPI 1407553019

Michaela Rose Blackwell, PA-C is a Physician Assistant in Rockford, Illinois. Qualified in 2023, 3 years ago. Practices with Orthomidwest, PLLC, a 537-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
3
Licensed in
IL
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

5875 E Riverside Blvd
Rockford, IL 61114-4937
Phone: (815) 398-9491
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085010688 (IL)

Record details

NPI number1407553019
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 14, 2023
Last updated in NPPESNovember 1, 2024
Certification dateNovember 1, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Orthomidwest, Pllc — 537 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Rockford