NPIMap

Individual provider Active NPI

Cameron Blank, PA

  • Physician Assistant
  • Chardon, OH
National Provider Identifier
1467097188
Registry record updated Jul 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1164435 Issued in OH
Practice address
13207 Ravenna Rd
Chardon, OH 44024-9523
Phone
(216) 844-7378
NPI assigned
Nov 18, 2019
Last updated
Jul 9, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1164435 OH Primary

Addresses

Primary practice location

13207 Ravenna Rd
Chardon, OH 44024-9523

Mailing address

13207 Ravenna Rd
Chardon, OH 44024-1686
Phone (216) 844-7378

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CameronBlank2@uhhospitals.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20220121002435 OH Practitioner - Physician Assistant 2668809443 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13221 Ravenna Rd
Chardon, OH 44024-9016

158 W Main Rd
Conneaut, OH 44030-2039

9000 Mentor Ave
Mentor, OH 44060-4497

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.15 of 100Reported as apm
Quality
82.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1164435OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Mar 1, 2022 Accepting new patients
University Primary Care Practices Inc Multi-Specialty CurrentSince Mar 1, 2022 Accepting new patients
University Primary Care Practices Past Accepting new patients
University Hospitals Medical Group Inc Multi-Specialty Past Accepting new patients

Locations

13207 Ravenna Rd
Chardon, OH 44024
Phone (440) 285-5004

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

Interoperability endpoints

  • Direct secure messaging: cameronblank2@uhhospitals.org
  • Direct secure messaging: cblank28356@ehrdirect.uhhospitals.org

Organizations & group practices 5

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

Hospital & facility affiliations 5

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": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657324800000",
    "number": "1467097188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13207 RAVENNA RD",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440241686",
            "telephone_number": "216-844-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13207 RAVENNA RD",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440249523",
            "telephone_number": "216-844-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "CAMERON",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-18",
        "last_updated": "2022-07-09",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "1164435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CameronBlank2@uhhospitals.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "13207 Ravenna Rd",
            "city": "Chardon",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440249523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chardon, OH

Sources for this page

Verify at the official NPI Registry.