Andrea Blake, ARNP – Gerontology Nurse Practitioner

Key facts

NPI: 1174637748
Entity type: Individual (NPI type 1)
Primary specialty: Gerontology Nurse Practitioner 363LG0600X
License: R162244 (MD)
Practice address: 1111 6TH Ave
East Tower Suite A100
Des Moines, IA 50314-2610
Phone: (515) 358-0011
NPI assigned: Aug 19, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Comprehensive Rehab Consultants PLLC Physical Medicine & Rehabilitation Physician · Middle River, MD · NPI 1710529771

Medicare reassignment Care Compare group NPD CO

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2005
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Comprehensive Rehab Consultants PLLC (251 clinicians)

Practice addresses (Care Compare)

11155 W 15TH PL
Lakewood, CO 80215-2898
Phone (312) 278-7075

12080 Bellaire Way
Thornton, CO 80241-3600
Phone (303) 450-2700

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CO
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
I20230801002997	CO	Practitioner - Nurse Practitioner	0547284408	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Comprehensive Rehab Consultants PLLC		Current since Jul 6, 2023	Accepting new patients

Locations

329 Exempla Cir
Lafayette, CO 80026
Phone (720) 639-2200

11155 W 15th Pl
Lakewood, CO 80215
Phone (720) 866-8400

7395 W Eastman Pl
Lakewood, CO 80227
Phone (303) 730-8000

12080 Bellaire Way
Thornton, CO 80241
Phone (303) 450-2700

415 W Golf Rd
Ste 26
Arlington Hts, IL 60005

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Gerontology Nurse Practitioner	363LG0600X	R162244	MD	Yes

Addresses

Primary practice location

1111 6TH Ave
East Tower Suite A100
Des Moines, IA 50314-2610

Mailing address

PO Box 1475
Des Moines, IA 50306-1475
Phone (515) 643-4973

Other identifiers

Identifier	Type	State	Issuer
0485813	Medicaid	IA

Other providers in Des Moines, IA

All providers in Des Moines, IA · Gerontology Nurse Practitioner in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2008. 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.

Verify at the official NPI Registry.