Andrew Elliott Blakley, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Dededo, GU
NPI 1992288989 · NPPES record last updated Jan 25, 2024
Key facts
- NPI
- 1992288989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NP0189 (GU)
- Practice address
- 133 Route 3
Dededo, GU 96929-6911 - Phone
- (671) 645-5500
- Fax
- (671) 645-5615
- NPI assigned
- Sep 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pacific Cardiology Consultants LLC
Blue Ocean Medical Group LLC
Practice addresses (Care Compare)
633 Gov Carlos G Camacho Rd
Suite 202
Tamuning, GU 96913-3195
Phone (671) 649-1001
655 Harmon Loop Rd
Suite 108
Dededo, GU 96929-6544
Phone (671) 633-4447
Merit-based Incentive Payment System (MIPS)
- Final score
- 79.22 of 100
- Quality
- 78.84
- Improvement activities
- 40
- Cost
- 61.61
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GU
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200324002566 | GU | Practitioner - Nurse Practitioner | 0345678439 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RE2535 | GU | MD | General Practice Registered Nurse |
| 827646 | TX | MD | General Practice Registered Nurse |
| AP139003 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Ocean Medical Group LLC | Current |
Accepting new patients | |
| Pacific Cardiology Consultants LLC | Current |
Accepting new patients | |
| Guam Healthcare Development Incorporated | Current |
Accepting new patients |
Locations
655 Harmon Loop Rd
Ste 108
Dededo, GU 96929
Phone (671) 633-4447
133 Route 3
Dededo, GU 96929
Phone (671) 645-5500
633 Gov Carlos G Camacho Rd
Ste 202
Tamuning, GU 96913
Phone (671) 646-0443
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | RE2535 | GU | |
| Family Nurse Practitioner | 363LF0000X | AP139003 | TX | |
| Family Nurse Practitioner | 363LF0000X | NP0189 | GU | Yes |
| General Practice Registered Nurse | 163WG0000X | 827646 | TX |
Addresses
Primary practice location
133 Route 3
Dededo, GU 96929-6911
Mailing address
202 Hilton Rd Unit 12
Tamuning, GU 96913-4097
Phone (671) 987-1542
Other practice location 1
5112 Harvard St
Amarillo, TX 79109-5806
Phone (806) 626-1542
Other providers in Dededo, GU
- Bryan Christopher Bansil
- Joleen Aguon Baza
- Dennis D. Beckworth
- Anthony G Bekkerman
- BJR
- Blue Continent Healthcare Guam Medical City LLC
- Blue Continent Healthcare Guam Medical City LLC
- Blue Ocean Medical Group LLC
- Trang Bui
- C V Alegria DDS Inc
All providers in Dededo, GU · Family Nurse Practitioner in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.