Individual provider Active NPI

Bobbi Blakeslee, RN

  • Certified Registered Nurse Anesthetist
  • Traverse City, MI
National Provider Identifier
1609633486
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
148330 Issued in NY
Practice address
1105 Sixth St
Traverse City, MI 49684-2386
Phone
(231) 935-5000
NPI assigned
Feb 28, 2024
Last updated
May 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704412619 MI
Certified Registered Nurse Anesthetist 367500000X 148330 NY Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2386

Mailing address

250 Colton Ave
Lackawanna, NY 14218-2635
Phone (716) 395-5585

Other names 1

  • Bobbi Brady Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240723002895 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 1850837162 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

4100 Park Forest Dr
Traverse City, MI 49684-7331
Phone (231) 392-8900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704412619MIMDRegistered Nurse
148330NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Group CurrentSince Jul 15, 2024 Accepting new patients
Munson Medical Center Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2025 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Center CurrentSince Feb 1, 2025 Accepting new patients
Munson Medical Group Nurse Anesthetist, Certified Registered CurrentSince Jul 15, 2024 Accepting new patients

Locations

2891 Momentum Pl
Chicago, IL 60689

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1105 Sixth St
Ste 103
Traverse City, MI 49684
Phone (231) 935-6455

1200 Sixth St
Ste 200
Traverse City, MI 49684

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

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 1

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": "1709078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1609633486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 COLTON AVE",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142182635",
            "telephone_number": "716-395-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842386",
            "telephone_number": "231-935-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKESLEE",
        "first_name": "BOBBI",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704412619",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "148330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOBBI",
            "last_name": "BRADY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.