Blaine Robert Boverhuis, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19085 Issued in MN

Practice address

6401 France Ave S
Edina, MN 55435-2104

Phone

(952) 924-2888

Fax

(952) 924-2880

NPI assigned

Jun 30, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment Care Compare group NPD
• Range Regional Health Services

  • Clinic/Center
  • Hibbing, MN
  • NPI 1669569265
  Medicare reassignment NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Fairview Express Care

  • Family Medicine Physician
  • Princeton, MN
  • NPI 1841673647
  NPD
• Range Regional Health Services

  • Durable Medical Equipment & Medical Supplies
  • International Falls, MN
  • NPI 1710954821
  NPD

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1275210338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2509 27TH AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554111001",
            "telephone_number": "651-403-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 FRANCE AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352104",
            "telephone_number": "952-924-2888",
            "fax_number": "952-924-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOVERHUIS",
        "first_name": "BLAINE",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Botros, PA-C
• Brian Patrick Bottenfield Jr., DC
• Sarah Bou Malham, MD
• Aden Osman Bouh
• Boundless Care LLC
• Carley M Bowe, NP
• Barbara Jean Bowers, MD
• Dawn Marie Bowker, RN, CNP
• Scott Robert Bowlby, DDS
• Carolyn Ann Bowles, MD

• Clinical Social Worker in Edina, MN
• Providers in Edina, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.