Active NPI
Blake Tiedtke, DPT
- Physical Medicine & Rehabilitation Physician
- Cedar Rapids, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 004341
- Practice address
- 645 32ND Ave SW
Ste a
Cedar Rapids, IA 52404-3907 - Phone
- (319) 363-2901
- Fax
- (319) 363-2903
- NPI assigned
- Feb 23, 2009
- Last updated
- Mar 4, 2020
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 004341 | IA | Primary |
Addresses
Primary practice location
645 32ND Ave SW
Ste a
Cedar Rapids, IA 52404-3907
Mailing address
3290 Ridgeway Dr
Ste 3
Coralville, IA 52241
Phone (319) 665-2630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
400 Collins Rd NE
Ms 154 100
Cedar Rapids, IA 52498-0505
Phone (319) 295-8899
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Match Play Tennis Centers, Inc. | Current | Accepting new patients |
Locations
400 Collins Rd NE
#154
Cedar Rapids, IA 52498
Phone (319) 295-8899
400 Collins Rd NE
#154100
Cedar Rapids, IA 52498
Phone (319) 295-8899
Organizations & group practices 1
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.
-
dba Rec Center Physical Therapy
- Physical Therapy Clinic/Center
- Cedar Rapids, IA
- NPI 1760540926
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583280000000",
"number": "1922248566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3290 RIDGEWAY DR",
"address_2": "STE 3",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "52241",
"telephone_number": "319-665-2630",
"fax_number": "319-665-2631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 32ND AVE SW",
"address_2": "STE A",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524043907",
"telephone_number": "319-363-2901",
"fax_number": "319-363-2903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIEDTKE",
"first_name": "BLAKE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-23",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IA",
"license": "004341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; 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.