Blake Alan Luebbehusen, MSN, RN, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71010668A Issued in IN

Practice address

500 Arcade Ave Ste 210
Elkhart, IN 46514-2485

Phone

(574) 389-5656

NPI assigned

Nov 23, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleanslate Medical Group of Indiana LLCGroup PAC ID 4880963909, 60 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bluebbehusen@mybeacon.cernerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cleanslate Medical Group of Indiana LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Alexandria, IN
  • NPI 1023464294

  IN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1154925907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 210",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142485",
            "telephone_number": "574-389-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUEBBEHUSEN",
        "first_name": "BLAKE",
        "middle_name": "ALAN",
        "credential": "MSN, RN, NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-23",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71010668A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "236040357",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300045960",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bluebbehusen@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "500 Arcade Ave Ste 210",
            "city": "Elkhart",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465142485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marlene Lozano-Trinidad, RBT
• Joselin Lucas Rojas
• Kent G Lucchesi, MD
• Angela G Lucterhand, D.C.
• Scott E Ludwig, MD
• Cing Lun
• Sarah Lusk
• Jennifer Marie Luster-Bartz, M.P.T
• Luxottica Retail North America Inc
• Alyssa Lynch

• All providers in Elkhart, IN
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.