Individual provider Active NPI

Garrett Coman, M.D.

  • Dermatology Physician
  • Ketchum, ID
National Provider Identifier
1306209556
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M-15211 Issued in ID
Practice address
St. Luke's Dermatology
191 5TH Street West
Ketchum, ID 83340
Phone
(208) 725-2171
NPI assigned
Apr 4, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M-15211 ID Primary

Addresses

Primary practice location

St. Luke's Dermatology
191 5TH Street West
Ketchum, ID 83340

Mailing address

University Hospital
30 N 1900 E Room 4C104
Salt Lake City, UT 84132

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200810003242 ID Practitioner - Dermatology 6608142138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Utah School of Medicine, 2015
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)

100 Hospital Dr
Ketchum, ID 83340

100 Hospital Dr
Ketchum, ID 83340-9998

191 5TH St W
Ketchum, ID 83340-9998
Phone (208) 725-2171

21 E Maple St
Suite a
Hailey, ID 83333-4900
Phone (208) 788-3200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision66
Removal of skin lesions1479
Removal of skin cancer53
Removal or shaving of skin growth1-10
Skin biopsy537

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-15211IDMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic - Wood River LLC CurrentSince Jul 15, 2020 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

21 E Maple St
Hailey, ID 83333
Phone (208) 788-3200

21 E Maple St
Ste 201
Hailey, ID 83333

211 W Forest St
McCall, ID 83638
Phone (208) 467-7546

211 W Forest St
Ste 201
McCall, ID 83638

Interoperability endpoints

  • Direct secure messaging: gcoman182417@direct.slhs.org

Organizations & group practices 1

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1306209556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY HOSPITAL",
            "address_2": "30 N 1900 E ROOM 4C104",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ST. LUKE'S DERMATOLOGY",
            "address_2": "191 5TH STREET WEST",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-725-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMAN",
        "first_name": "GARRETT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-04",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M-15211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchum, ID

Sources for this page

Verify at the official NPI Registry.