Henry Keiler Bluhm Jr., PA-C
Individual provider Active NPI Medical Physician Assistant · Eldon, MO
NPI 1104096429 · NPPES record last updated Aug 29, 2018
Key facts
- NPI
- 1104096429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 2011035886 (MO)
- Practice address
- 304A E 4TH St
Eldon, MO 65026 - Phone
- (573) 557-2400
- Fax
- (573) 557-2401
- NPI assigned
- Mar 3, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Springfield Communities
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
- Mercy Hospital Lebanon
- Mercy Hospital Springfield
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181004002327 | MO | Practitioner - Physician Assistant | 6507042777 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-461 | AR | MD | Physician Assistant |
| 2011035886 | MO | MD | Medical Physician Assistant |
| 0110002717 | VA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Current |
Accepting new patients | |
| Mercy Clinic Springfield Communities | Current |
Accepting new patients | |
| Mercy Clinic Springfield Communities | Current |
Accepting new patients | |
| Family Medical Walk-in Clinic PA | Past |
Accepting new patients | |
| Medexpress Urgent Care Arkansas, P.a. | Past | Accepting new patients |
Locations
1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379
1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-461 | AR | |
| Medical Physician Assistant | 363AM0700X | 0110002717 | VA | |
| Medical Physician Assistant | 363AM0700X | 2011035886 | MO | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2011035886 | Other | MO | STATE LICENSE |
Other providers in Eldon, MO
- BC King DDS PC
- Brandon Keith Bennett
- Paul Bernabe
- Jeanell Bertels
- Kayla Jean Blaes
- Megan Boehmer
- Dennis R. Bond
- Brandon K Bennett DDS LLC
- Bristol Care, Inc.
- Renate Brodecker
All providers in Eldon, MO · Medical Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2018. 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.