Blake Michael Bodendorfer, M.D.
Individual provider Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Council Bluffs, IA
NPI 1083000905 · NPPES record last updated Aug 2, 2021
Key facts
- NPI
- 1083000905
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- License
- 036152051 (IL)
- Practice address
- 1 Edmundson PL Ste 500
Council Bluffs, IA 51503-4619 - Phone
- (712) 323-5333
- NPI assigned
- Apr 7, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 26
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- University of Missouri, Columbia School of Medicine, 2015
- Medicare assignment
- May accept Medicare assignment
- Group practices
- MD West One PC
Shelby County Chris a Myrtue Memorial Hospital
Sports Rehab and Professional Therapy Associates Inc
Alegent Creighton Clinic
Practice addresses (Care Compare)
1 Edmundson PL
Suite 200
Council Bluffs, IA 51503-4658
Phone (402) 390-4111
1213 Garfield Ave
Harlan, IA 51537-2057
Phone (712) 755-5161
222 N 192ND St
Elkhorn, NE 68022-2811
Phone (402) 390-4111
315 W 5TH St
Storm Lake, IA 50588-1743
Phone (712) 732-7724
7710 Mercy Rd
Suite 2000
Omaha, NE 68124-2323
Phone (402) 717-0820
800 Mercy Dr
Council Bluffs, IA 51503-3128
Phone (712) 328-5490
Hospital & facility affiliations
- CHI Health Lakeside
- CHI Health Midlands
- Myrtue Medical Center
- Methodist Jennie Edmundson
- The Nebraska Methodist Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Knee replacement | 1-10 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 20 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of tissue | 1-10 |
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA, NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210709002703 | IA | Practitioner - Orthopedic Surgery | 0547686313 | Reassigns benefits to 9 organizations |
| I20210817002235 | NE | Practitioner - Orthopedic Surgery | 0547686313 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MD West One, PC | Current |
Accepting new patients | |
| MD West One, PC | Current |
Accepting new patients | |
| Clarinda Regional Health Center | Current |
Accepting new patients | |
| Alegent Creighton Clinic | Current |
Accepting new patients | |
| Alegent Creighton Clinic | Current |
Accepting new patients |
Locations
1501 E 10th St
Atlantic, IA 50022
Phone (712) 243-2850
220 Essie Davison Dr
Clarinda, IA 51632
Phone (712) 542-8330
800 Mercy Dr
Council Bluffs, IA 51503
Phone (712) 328-5000
800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660
1 Edmundson Pl
Ste 200
Council Bluffs, IA 51503
Phone (712) 243-3250
2959 US Highway 275
Hamburg, IA 51640
Phone 71238215158070
2959 US Highway 275
#C
Hamburg, IA 51640
1213 Garfield Ave
Harlan, IA 51537
Phone (712) 755-4316
2771 Solution Ctr
Chicago, IL 60677
3308 Samson Way
Bellevue, NE 68123
Phone (402) 291-3373
222 N 192nd St
Elkhorn, NE 68022
7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248
7710 Mercy Rd
Ste 2000
Omaha, NE 68124
Phone (402) 717-0820
8005 Farnam Dr
Ste 305
Omaha, NE 68114
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 036152051 | IL | Yes |
Addresses
Primary practice location
1 Edmundson PL Ste 500
Council Bluffs, IA 51503-4619
Mailing address
1611 W Harrison St Ste 400
Chicago, IL 60612-4861
Phone (312) 432-2351
Other providers in Council Bluffs, IA
- Bluffs Pain Management LLC
- Bluffs Pain Management LLC
- Bluffs Taxi & Courier Inc
- Joan Marie Blum
- Karen M Bober
- Karly Boehm
- Clifford Kent Boese
- Bogaard and Associates, LLC
- Jessica Sage Boldenow
- Scott B Bomgaars
All providers in Council Bluffs, IA · Sports Medicine (Orthopaedic Surgery) Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.