Blake Michael Bodendorfer, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

036152051 Issued in IL

Practice address

1 Edmundson PL Ste 500
Council Bluffs, IA 51503-4619

Phone

(712) 323-5333

NPI assigned

Apr 7, 2015

Last updated

Aug 2, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, NE2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Orthopedic Surgery

Education

University of Missouri, Columbia School of Medicine, 2015

Medicare assignment

May accept Medicare assignment

Group practices

MD West One PCGroup PAC ID 0446228852, 89 clinicians

Shelby County Chris a Myrtue Memorial HospitalGroup PAC ID 5193619393, shared by 12 NPIs, 49 clinicians

Sports Rehab and Professional Therapy Associates IncGroup PAC ID 1658289608, 124 clinicians

Alegent Creighton ClinicGroup PAC ID 1951210418, shared by 2 NPIs, 951 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Health Lakeside Hospital, Omaha, NE, CCN 280130
• CHI Health Midlands Hospital, Papillion, NE, CCN 280105
• Myrtue Medical Center Hospital, Harlan, IA, CCN 161374
• Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047
• The Nebraska Methodist Hospital Hospital, Omaha, NE, CCN 280040

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• MD West One, PC

  • Neurological Surgery Physician
  • Omaha, NE
  • NPI 1588616767

  IA

  Medicare reassignment Care Compare group NPD
• Alegent Creighton Clinic

  dba CHI Health Clinic

  • Family Medicine Physician
  • Council Bluffs, IA
  • NPI 1598811069
  Medicare reassignment NPD
• Clarinda Regional Health Center

  dba Clarinda Medical Associates

  • Family Medicine Physician
  • Clarinda, IA
  • NPI 1629196241
  Medicare reassignment NPD
• Alegent Creighton Clinic

  dba CHI Health Clinic

  • Family Medicine Physician
  • Omaha, NE
  • NPI 1548287907
  Medicare reassignment NPD
• Community Hospital Inc

  • Emergency Medicine Physician
  • Hamburg, IA
  • NPI 1124112677
  Medicare reassignment
• Community Hospital Inc

  dba George C. Grape Community Hospital

  • Critical Access Hospital
  • Hamburg, IA
  • NPI 1932294071
  Medicare reassignment
• Montgomery County Memorial Hospital

  • Internal Medicine Physician
  • Red Oak, IA
  • NPI 1265405310
  Medicare reassignment
• Montgomery County Memorial Hospital

  • Critical Access Hospital
  • Red Oak, IA
  • NPI 1376539338
  Medicare reassignment
• Shelby County Chris a Myrtue Memorial Hospital

  dba Myrtue Medical Center

  • Critical Access Hospital
  • Harlan, IA
  • NPI 1598871469
  Medicare reassignment
• Shelby County Chris a. Myrtue Memorial Hospital

  dba Myrtue Medical Center

  • Family Medicine Physician
  • Harlan, IA
  • NPI 1922184175
  Medicare reassignment
• Sports Rehab and Professional Therapy Associates Inc

  dba Sports Rehab & Professional Therapy

  • Rehabilitation Clinic/Center
  • Storm Lake, IA
  • NPI 1033289749
  Care Compare group
• MD West One, PC

  • Durable Medical Equipment & Medical Supplies
  • Elkhorn, NE
  • NPI 1740933530
  NPD

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

• Jennie Edmundson Memorial Hospital

  dba Methodist Jennie Edmundson

  • General Acute Care Hospital
  • Council Bluffs, IA
  • NPI 1457448755
  Care Compare affiliation
• Shelby County Chris a Myrtue Memorial Hospital

  dba Myrtue Medical Center

  • Critical Access Hospital
  • Harlan, IA
  • NPI 1598871469
  Care Compare affiliation
• Alegent Creighton Health

  dba CHI Health Midlands

  • General Acute Care Hospital
  • Papillion, NE
  • NPI 1215006101
  Care Compare affiliation
• Alegent Creighton Health

  dba CHI Health Lakeside

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1649355132
  Care Compare affiliation
• Nebraska Methodist Hospital

  dba Methodist Hospital

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1427147883
  Care Compare affiliation

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1083000905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "312-432-2351",
            "fax_number": "708-409-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EDMUNDSON PL STE 500",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034619",
            "telephone_number": "712-323-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODENDORFER",
        "first_name": "BLAKE",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-07",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IL",
            "license": "036152051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Orthopaedic Surgery) Physician in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.