Individual provider Active NPI

Lucas P Belford, PA

  • Physician Assistant
  • Blackfoot, ID
National Provider Identifier
1104394337
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1676 Issued in ID
Practice address
700 E Alice St
Blackfoot, ID 83221-4925
Phone
(208) 785-1200
NPI assigned
Nov 6, 2018
Sex
Male
Sole proprietor
No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Medicare Care Compare profile

Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Directors of Idaho PLLC (19 clinicians)

Practice addresses (Care Compare)

2814 S Indiana Ave
Caldwell, ID 83605-5925
Phone (208) 459-0808

331 E Park St
Weiser, ID 83672-2053
Phone (208) 549-2416

6000 W Denton St
Boise, ID 83704-9310
Phone (208) 629-4383

620 N 6TH St
Bellevue, ID 83313-5174
Phone (208) 788-7180

8211 W Ustick Rd
Boise, ID 83704-5756
Phone (208) 375-3700

909 E Reserve St
Boise, ID 83712-6508
Phone (208) 343-7717

Hospital & facility affiliations

  • St Luke'S Wood River Medical Center Hospital · Ketchum, ID · CCN 131323
  • St Luke'S Regional Medical Center Hospital · Boise, ID · CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital · Boise, ID · CCN 130007

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20200515000862 ID Practitioner - Physician Assistant 3971934597 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prestige Worldwide LPB LLC Current Accepting new patients

Locations

413 N Allumbaugh St
Ste 101
Boise, ID 83704
Phone (208) 323-1125

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1676 ID Primary

Addresses

NPPES NPI Registry

Primary practice location

700 E Alice St
Blackfoot, ID 83221-4925

Mailing address

909 E Reserve St
Boise, ID 83712-6508
Phone (502) 544-1780

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 21, 2023.

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1104394337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E RESERVE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126508",
            "telephone_number": "502-544-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E ALICE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832214925",
            "telephone_number": "208-785-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELFORD",
        "first_name": "LUCAS",
        "middle_name": "P",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-06",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, ID

Sources for this page

Verify at the official NPI Registry.