NPIMap

Individual provider Active NPI

Grayson W Blomberg, PA-C

  • Surgical Physician Assistant
  • Plymouth, MN
National Provider Identifier
1003057118
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10560 Issued in MN
Practice address
15700 37TH Ave N Ste 150
Plymouth, MN 55446-3675
Phone
(651) 968-5201
NPI assigned
Mar 19, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 10560 MN Primary

Addresses

Primary practice location

15700 37TH Ave N Ste 150
Plymouth, MN 55446-3675

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090507000320 MN Practitioner - Physician Assistant 2668520354 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Orthopedics, LTDGroup PAC ID 8921900374, 282 clinicians

Practice addresses (Care Compare)

10230 Baltimore St NE
Blaine, MN 55449-4674
Phone (651) 968-5201

1661 Saint Anthony Ave
Saint Paul, MN 55104-3733
Phone (651) 968-5201

2090 Woodwinds Dr
Saint Paul, MN 55125-2522
Phone (651) 968-5201

3580 Arcade St
Vadnais Heights, MN 55127-7135
Phone (651) 968-5201

6050 Sycamore LN N
Plymouth, MN 55442-1402
Phone (651) 968-5201

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10560MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Orthopedics, LTD. CurrentSince Jan 1, 2016 Accepting new patients
Summit Orthopedics LTD CurrentSince Jan 1, 2016 Accepting new patients
Summit Orthopedics LTD Current Accepting new patients
Welia Health CurrentSince Jan 15, 2024 Accepting new patients
Ilbnc, P.a. Past Accepting new patients

Locations

10230 Baltimore St NE
#300
Blaine, MN 55449
Phone (651) 968-5300

800 Freeport Ave NW
Ste 100
Elk River, MN 55330
Phone (763) 581-5200

2800 Chicago Ave
Ste 402
Minneapolis, MN 55407
Phone (612) 879-8084

301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317

15700 37th Ave N
Ste 150
Plymouth, MN 55446
Phone (651) 968-1627

6050 Sycamore Ln N
Plymouth, MN 55442
Phone (651) 968-5462

1661 Saint Anthony Ave
Saint Paul, MN 55104
Phone (651) 968-5335

2620 Eagan Woods Dr
Saint Paul, MN 55121
Phone (651) 271-1592

3580 Arcade St
Vadnais Heights, MN 55127
Phone (651) 968-5770

710 Commerce Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5042

Interoperability endpoints

  • Direct secure messaging: gblomberg2181@excellian.direct.allina.com
  • Direct secure messaging: graysonblomberg@sol.allscriptsdirect.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 25

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003057118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925",
            "telephone_number": "651-968-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 37TH AVE N STE 150",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463675",
            "telephone_number": "651-968-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOMBERG",
        "first_name": "GRAYSON",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "10560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.