Individual provider Active NPI

Jodee L Blaze, CRNA

  • Certified Registered Nurse Anesthetist
  • Fargo, ND
National Provider Identifier
1093955593
Registry record updated Feb 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R34791 Issued in ND
Practice address
737 Broadway N
Fargo, ND 58102-4421
Phone
(701) 234-6258
NPI assigned
Feb 24, 2009
Last updated
Feb 22, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R 152598-2 MN
Certified Registered Nurse Anesthetist 367500000X R34791 ND Primary

Addresses

Primary practice location

737 Broadway N
Fargo, ND 58102-4421

Mailing address

737 Broadway N
Fargo, ND 58102-4421
Phone (701) 234-6258

Other identifiers 2

IdentifierTypeStateIssuer
1093955593MedicaidMN
P00733656OtherMNMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100212000139 ND Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305997131 Reassigns benefits to 3 organizations
I20160420002255 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305997131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians
Sanford Health NetworkGroup PAC ID 6800707100, 357 clinicians
Lutheran Charity AssociationGroup PAC ID 2264341031, shared by 6 NPIs, 168 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

20 S Plum St
Vermillion, SD 57069-3346
Phone (605) 624-9111

2422 20TH St SW
Jamestown, ND 58401-6201
Phone (701) 252-1050

2905 3Rd Ave SE
Aberdeen, SD 57401-5420
Phone (605) 626-4200

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

701 3Rd Ave S
Clear Lake, SD 57226-2016
Phone (605) 874-2141

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
85.53 of 100Reported as group
Quality
80.98
Promoting interoperability
100
Improvement activities
40
Cost
70.78

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
R 152598-2MNMDCertified Registered Nurse Anesthetist
R34791NDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network Current Accepting new patients
Lutheran Charity Association Nurse Anesthetist, Certified Registered CurrentSince May 1, 2022 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Lutheran Charity Association CurrentSince May 1, 2022 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Sanford Health Network CurrentSince Jan 13, 2023 Accepting new patients

Locations

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

2905 3rd Ave SE
Aberdeen, SD 57401
Phone (605) 226-5500

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

20 S Plum St
Vermillion, SD 57069
Phone (605) 624-2611

Organizations & group practices 8

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266796800000",
    "number": "1093955593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024421",
            "telephone_number": "701-234-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024421",
            "telephone_number": "701-234-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZE",
        "first_name": "JODEE",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-24",
        "last_updated": "2010-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 152598-2",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R34791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093955593",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00733656",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.