Individual provider Active NPI

Jeremy Blauser, MS, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1669008702
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5645 W Addison St
Chicago, IL 60634-4403
Phone
(773) 282-7000
NPI assigned
Mar 20, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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 Primary

Addresses

Primary practice location

5645 W Addison St
Chicago, IL 60634-4403

Mailing address

5645 W Addison St
Chicago, IL 60634-4403

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200610003157 IL Practitioner - Physician Assistant 4183045537 Reassigns benefits to 1 organization
I20210629001472 NC Practitioner - Physician Assistant 4183045537 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rush Medical College of Rush University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iredell Physician Network LLCGroup PAC ID 0749345007, 91 clinicians

Practice addresses (Care Compare)

Statesville, NC 28677
Phone (704) 838-2182

1540 E Broad St
Statesville, NC 28625-4302

766 Hartness Rd
Suite B
Statesville, NC 28677-3479

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iredell Physician Network LLC CurrentSince Jun 1, 2021 Accepting new patients
Community First Healthcare of Illinois, Inc. CurrentSince Apr 1, 2020 Accepting new patients
Iredell Physician Network LLC CurrentSince Jun 1, 2021 Accepting new patients

Locations

5645 W Addison St
Chicago, IL 60634
Phone (773) 282-7000

653 Bluefield Rd
Ste A
Mooresville, NC 28117
Phone (704) 360-6460

766 Hartness Rd
Statesville, NC 28677
Phone (704) 838-2182

1540 E Broad St
Statesville, NC 28625
Phone (704) 230-4382

Organizations & group practices 6

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 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": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1669008702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 W ADDISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606344403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 W ADDISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606344403",
            "telephone_number": "773-282-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAUSER",
        "first_name": "JEREMY",
        "name_prefix": "Mr.",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-20",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.