Joel Andrew Carlson, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

O-0407 Issued in ID

Practice address

777 Hospital Way
BLDG a Suite 300
Pocatello, ID 83201-5176

Phone

(208) 233-1720

Fax

(208) 239-3403

NPI assigned

Jan 18, 2006

Last updated

Jul 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Clinic - Wood River LLCGroup PAC ID 3173783818, 66 clinicians

Practice addresses (Care Compare)

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jcarlson163354@direct.slhs.org

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

• St Lukes Clinic - Wood River LLC

  • Internal Medicine Physician
  • Ketchum, ID
  • NPI 1972891604

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD

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

• St Lukes Regional Medical Center

  dba Air St Luke's

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation
• St Lukes Wood River Medical Center LTD

  dba St Lukes Wood River Medical Center

  • Critical Access Hospital
  • Ketchum, ID
  • NPI 1508869470
  Care Compare affiliation

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1144200916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "address_2": "BLDG A SUITE 300",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015176",
            "telephone_number": "208-233-1720",
            "fax_number": "208-239-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "address_2": "BLDG A SUITE 300",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015176",
            "telephone_number": "208-233-1720",
            "fax_number": "208-239-3403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JOEL",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IA",
            "license": "3140",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "O-0407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "S6109",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE-BLUE SHIELD",
            "identifier": "000010156981",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807508700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "546490",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00355281",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Care Planning Institute, Inc
• Carl B. Holm, D.D.S., P.C.
• Brady Carlen, DDS
• Breanna Carlos
• Janie Carlson, LSW
• Saunja Carlson, M.S. SLP-CF
• Emilia Marie Carrillo
• Taylor Carson, OTR/L
• Ashley Carter
• Linda E Carter, MD

• Obstetrics & Gynecology Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Obstetrics & Gynecology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.