Active NPI
Blake Pollema, ATC
- Athletic Trainer
- Pueblo, CO
National Provider Identifier
1669872594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000017573
- Practice address
- 1337 Gray Wolf Cir
Pueblo, CO 81001-4932 - Phone
- (320) 241-2514
- NPI assigned
- Aug 28, 2014
- Last updated
- Aug 7, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000017573 | ND | Primary |
Addresses
Primary practice location
1337 Gray Wolf Cir
Pueblo, CO 81001-4932
Mailing address
34382 County Road 89
Browerville, MN 56438
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000017573 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565136000000",
"number": "1669872594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34382 COUNTY ROAD 89",
"city": "BROWERVILLE",
"state": "MN",
"postal_code": "56438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1337 GRAY WOLF CIR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810014932",
"telephone_number": "320-241-2514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLEMA",
"first_name": "BLAKE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-28",
"last_updated": "2019-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "2000017573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.