NPIMap

Organization Active NPI

Family Medicine Hub PLLC

Doing business as Blair Family Medicine

  • Nurse Practitioner
  • Idaho Falls, ID
National Provider Identifier
1134620107
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
FAMILY MEDICINE HUB PLLC
Practice address
2001 S Woodruff Ave Ste 15B
Idaho Falls, ID 83404-6372
Phone
(208) 357-4633
Fax
(208) 419-0690
NPI assigned
Feb 26, 2018
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Shelly Cameron
Title
Practice Manager
Phone
(208) 357-4633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

2001 S Woodruff Ave Ste 15B
Idaho Falls, ID 83404-6372

Mailing address

2001 S Woodruff Ave Ste 15B
Idaho Falls, ID 83404-6372
Phone (208) 357-4633

Other identifiers 1

IdentifierTypeStateIssuer
1629128483MedicaidID

Other names 1

  • Blair Family Medicine Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180424000806 ID Part B Supplier - Clinic/Group Practice 9537422662 Receives reassigned benefits from 10 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1134620107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 15B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046372",
            "telephone_number": "208-357-4633",
            "fax_number": "208-419-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 15B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046372",
            "telephone_number": "208-357-4633",
            "fax_number": "208-419-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE HUB PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-26",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "CAMERON",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-357-4633"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629128483",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blair Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blair Family Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Blair Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.