DR. BLAKE EDWIN PEDERSEN D.O.
NPI 1790994283
Anesthesiology in Saint Louis, MO
About Dr. Blake Edwin Pedersen D.o. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. BLAKE EDWIN PEDERSEN D.O. (NPI 1790994283) is an individual anesthesiology provider in Saint Louis, Missouri, licensed in Missouri (2007001632) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with St Lukes Magic Valley Medical Center, and is a graduate of Other (2004).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Blake Edwin Pedersen D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Blake Pedersen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Twin Falls, ID 83301
- Reassigned Medicare billing, Idaho enrollment
- Medicare enrollment name: St Lukes Clinic LLC
- 322 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
St Lukes Magic Valley Medical Center
Acute Care Hospitals · Twin Falls, IDMedicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAINT LOUIS, MO 63110
SAINT LOUIS, MO 63110
SAINT LOUIS, MO 63110
SAINT LOUIS, MO 63110
SAINT LOUIS, MO 63110
SAINT LOUIS, MO 63110
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Blake Pedersen's NPI number?
The NPI number for Blake Pedersen is 1790994283. It was assigned to this individual provider in the NPPES registry on May 21, 2007.
Where is Blake Pedersen located?
Blake Pedersen practices at 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110. The listed phone number is (314) 362-6978.
What is Blake Pedersen's specialty?
The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.
Is Blake Pedersen enrolled in Medicare?
Yes. Blake Pedersen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Blake Pedersen's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Blake Pedersen reassigns Medicare benefits to St Luke's Clinic LLC (Twin Falls, ID). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Blake Pedersen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Blake Pedersen affiliated with any hospitals?
According to CMS data, Blake Pedersen is affiliated with St Lukes Magic Valley Medical Center.
When was this NPI record last updated?
The NPPES record for Blake Pedersen was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Blake Edwin Pedersen, D.O. · NPI 1790994283
Anesthesiology physician in Saint Louis, Missouri. Individual provider, active in the CMS NPPES registry since May 21, 2007.
## Identity
- **NPI:** 1790994283 (Entity type: Individual)
- **Enumerated:** May 21, 2007
- **Primary specialty:** Anesthesiology · taxonomy 207L00000X
- **State license:** 2007001632 (Missouri)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1 BARNES JEWISH HOSPITAL PLZ, Saint Louis, MO 63110-1003
- **Phone:** (314) 362-6978
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** St Luke's Clinic LLC (NPI 1790718229, Twin Falls, ID), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2004
## Record status
- **NPPES last updated:** July 8, 2007
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Source: [NPI Profile](https://npiprofile.com/npi/1790994283) · Data from the CMS NPPES public registry.