Look up the most recent NPI and PECOS records

Grant Michael Blauvelt

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7900 W Jefferson Blvd Ste 201, Fort Wayne, IN 46804-4128

PECOS Enrollment

This provider is enrolled in PECOS as GRANT BLAUVELT.

Based on the most recent information from CMS, provider Grant Michael Blauvelt is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1477122711
Provider Type
Individual
Full Name
Blauvelt, Grant Michael
Title
Mr.
Credential
MSN, FNP-BC

Gender
Male
Sole Proprietor
No
Enumeration Date
6/22/2021
Last Updated
12/17/2021

Contact Information

Practice Location

7900 W Jefferson Blvd Ste 201, Fort Wayne, IN 46804-4128

(260) 432-2297

Unlisted Fax

Mailing Location

6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934

(260) 479-3514

(260) 479-3520

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 71011228A Indiana

Grant Michael Blauvelt

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Pashova, Vivian

Flack, Abigail

Elliott, Ann Natasha

Howard, Amy M

Gundersen Watson, Gay

Kintz, Sadie S.

Colclesser, Felicia Anne

Payton, Angela M.

Roberts, Catherine S.

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