NPIMap

Individual provider Active NPI

Henry Keiler Bluhm Jr., PA-C

  • Medical Physician Assistant
  • Eldon, MO
National Provider Identifier
1104096429
Registry record updated Aug 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2011035886 Issued in MO
Practice address
304A E 4TH St
Eldon, MO 65026
Phone
(573) 557-2400
Fax
(573) 557-2401
NPI assigned
Mar 3, 2008
Last updated
Aug 29, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-461 AR
Medical Physician Assistant 363AM0700X 0110002717 VA
Medical Physician Assistant 363AM0700X 2011035886 MO Primary

Addresses

Primary practice location

304A E 4TH St
Eldon, MO 65026

Mailing address

1005 SE Walton Blvd
Bentonville, AR 72712-6775
Phone (479) 254-6734

Other practice location 1

1005 SE Walton Blvd
Bentonville, AR 72712-6775
Phone (479) 254-6734

Other identifiers 1

IdentifierTypeStateIssuer
2011035886OtherMOSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20181004002327 MO Practitioner - Physician Assistant 6507042777 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

120 Hospital Dr
Lebanon, MO 65536-9227

120 Hospital Dr
Lebanon, MO 65536-9230
Phone (417) 820-5750

1605 Martin Springs Dr
Rolla, MO 65401-2980

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110002717VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Jul 22, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jul 22, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jul 22, 2024 Accepting new patients
Family Medical Walk-in Clinic PA PastSince Feb 1, 2011 Accepting new patients
Medexpress Urgent Care Arkansas, P.a. Past Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Organizations & group practices 5

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 11

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": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535500800000",
    "number": "1104096429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 SE WALTON BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727126775",
            "telephone_number": "479-254-6734",
            "fax_number": "479-254-6836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304A E 4TH ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "65026",
            "telephone_number": "573-557-2400",
            "fax_number": "573-557-2401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1005 SE Walton Blvd",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727126775",
            "country_code": "US",
            "telephone_number": "479-254-6734",
            "fax_number": "479-254-6836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUHM",
        "first_name": "HENRY",
        "middle_name": "KEILER",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-03",
        "last_updated": "2018-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-461",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002717",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2011035886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2011035886",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldon, MO

Sources for this page

Verify at the official NPI Registry.