NPIMap

Individual provider Active NPI

Blake Hunter Cedarleaf, PA-C

  • Surgical Physician Assistant
  • Saint Cloud, MN
National Provider Identifier
1154967156
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
13252 Issued in MN
Practice address
1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone
(320) 251-2700
NPI assigned
Nov 25, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 13252 MN Primary

Addresses

Primary practice location

1406 6TH Ave N
Saint Cloud, MN 56303-1900

Mailing address

16832 Linden Ave
Grasston, MN 55030-4506
Phone (651) 528-9173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20200127002413 MN Practitioner - Physician Assistant 1355776014 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Jan 1, 2020 Accepting new patients
Centracare Health System - Long Prairie CurrentSince Jan 1, 2020 Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Jan 1, 2020 Accepting new patients
Centracare Clinic CurrentSince Jan 1, 2020 Accepting new patients
Centracare Clinic CurrentSince Jan 1, 2020 Accepting new patients
Centracare Health-Paynesville LLC CurrentSince Jan 1, 2020 Accepting new patients

Locations

50 Centracare Dr
Long Prairie, MN 56347
Phone (320) 732-2131

525 Main St W
Melrose, MN 56352
Phone (320) 256-4228

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

200 W 1st St
Paynesville, MN 56362
Phone (320) 243-3767

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

425 Elm St N
Sauk Centre, MN 56378
Phone (320) 352-2221

Interoperability endpoints

  • Direct secure messaging: bcedarleaf497131@direct.centracare.com

Organizations & group practices 11

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.

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": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1154967156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16832 LINDEN AVE",
            "city": "GRASSTON",
            "state": "MN",
            "postal_code": "550304506",
            "telephone_number": "651-528-9173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-251-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEDARLEAF",
        "first_name": "BLAKE",
        "middle_name": "HUNTER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "13252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.