Blaine County

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

BLAINE COUNTY

Practice address

480 E Avenue N
Ketchum, ID 83340

Phone

(208) 788-5505

NPI assigned

Jul 29, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jolynn Drage

Title

Clerk, Auditor and Recorder

Phone

(208) 788-5505

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Blaine County Ambulance District Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1083614036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 S 1ST AVE",
            "address_2": "SUITE 200",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 E AVENUE N",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-788-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAINE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "DRAGE",
        "authorized_official_first_name": "JOLYNN",
        "authorized_official_title_or_position": "CLERK, AUDITOR AND RECORDER",
        "authorized_official_telephone_number": "208-788-5505"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRB",
            "identifier": "590014405",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805848400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805848500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blaine County Ambulance District",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blaine County Ambulance District",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Maisin Buoncristiani, MD
• Sarah Armstrong, DPT
• Erin R Barker, PA-C
• Jennifer Anne-Liebersbach Bertovich, DC
• Hadi Bhurgri, MD
• Margret J. Blair, L.AC.
• Herbert Aaron Blaser, DDS
• Christopher Bodle, M.D.
• Melissa A Boley, LPCP
• Karen Bommentre, LMFT

• All providers in Ketchum, ID
• Land Ambulance in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.