Active NPI
BMH Inc
Doing business as Physicians and Surgeons of Shelley
- Rural Health Clinic/Center
- Shelley, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- License
- 36
- Legal business name
- BMH INC
- Doing business as
- Physicians and Surgeons of Shelley
- Practice address
- 275 W Locust St
Shelley, ID 83274-1230 - Phone
- (208) 782-2960
- NPI assigned
- Oct 9, 2007
- Last updated
- Feb 11, 2021
- Organization subpart
- Yes
- Parent organization
- BMH INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jacob Erickson
- Title
- Ceo
- Phone
- (208) 785-3801
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 36 | ID | Primary |
| Urgent Care Clinic/Center | 261QU0200X | NU |
Addresses
Primary practice location
275 W Locust St
Shelley, ID 83274-1230
Mailing address
275 W Locust St
Shelley, ID 83274-1230
Phone (208) 782-2960
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807947000 | Medicaid | ID | |
| 000010137702 | Other | ID | BLUE SHIELD OF IDAHO |
| 8N304 | Other | ID | BLUE CROSS OF IDAHO |
Other names 1
- Physicians and Surgeons of Shelley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080414000440 | ID | Part A Provider - Rural Health Clinic | 8426149758 | Practice locations: Shelley, ID |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1366630949. Details of each certification follow.
Rural health clinic certification: CCN 138512
- Legal name
- BMH INC
- Doing business as
- BINGHAM MEMORIAL PHYSICIANS & SURGEONS CLINIC OF SHELLEY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 6, 2007
- Last certification
- Nov 6, 2007
- Ownership / control type
- 2B
- Most recent change of ownership
- Nov 7, 2007 (1 total)
- Organization structure
- Corporation
- Incorporated
- Jun 26, 2006 in ID
- Enrollment address
- 275 W Locust St
Shelley, ID 83274-1230 - Related CCNs
- 131325
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba First Choice Urgent Care and Medical Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1922243088
8426149758
-
dba Idaho Physicians Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1770785875
8426149758
-
dba Bingham Memorial Skilled Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Blackfoot, ID
- NPI 1861694960
8426149758
-
dba Bingham Memorial Physicians & Surgeons Center
- Surgery Physician
- Blackfoot, ID
- NPI 1255539193
8426149758
National Provider Directory
National Provider Directory- Tax ID family
- BMH Inc
- Part of
- BMH Inc
Other organizations with this tax ID 27
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Bingham Memorial Extended Care Facility
- Skilled Nursing Facility
- Blackfoot, ID
- NPI 1992785307
-
- Medicare Defined Swing Bed Hospital Unit
- Blackfoot, ID
- NPI 1689876781
-
- Critical Access Hospital
- Pocatello, ID
- NPI 1972412021
-
- Critical Access Hospital
- Blackfoot, ID
- NPI 1982805271
-
dba Bingham Memorial Specialist of Idaho Falls
- Pain Medicine Physician
- Idaho Falls, ID
- NPI 1073032413
-
dba Idaho Orthopaedic & Sports Clinic, P.A.
- Sports Medicine (Orthopaedic Surgery) Physician
- Pocatello, ID
- NPI 1114445087
-
dba 1st Choice Urgent Care Bannock Highway
- Multi-Specialty Clinic/Center
- Pocatello, ID
- NPI 1548727571
-
dba Pocatello Women's Health Clinic
- Obstetrics & Gynecology Physician
- Pocatello, ID
- NPI 1659887511
Locations
275 W Locust St
Shelley, ID 83274
Phone (208) 357-3960
Ownership & related parties
All disclosed owners & managing parties 14
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Brian R Thomas | Corporate Officer | Jan 1, 2024 | |
| Corporate Director | Jan 1, 2024 | ||
| Randall J Nightengale | Corporate Officer | Feb 1, 2020 | |
| Corporate Director | Feb 1, 2020 | ||
| Jacob Erickson | W-2 Managing Employee | Oct 1, 2017 | |
| Scott Reese | Corporate Officer | Jan 25, 2021 | |
| Corporate Director | Jan 25, 2021 | ||
| Jessica Lewis | Corporate Officer | Feb 1, 2019 | |
| Corporate Director | Feb 1, 2019 | ||
| Whitney Manwaring | Corporate Officer | Jan 30, 2023 | |
| Corporate Director | Jan 30, 2023 | ||
| Luke Jolley | Corporate Officer | Jan 30, 2023 | |
| Corporate Director | Jan 30, 2023 | ||
| Christian Cannon | Corporate Officer | Sep 27, 2021 | |
| Corporate Director | Sep 27, 2021 | ||
| Kevin Kotter | Corporate Officer | Jan 1, 2020 | |
| Corporate Director | Jan 1, 2020 | ||
| William J Sponenburgh | Corporate Officer | Feb 28, 2022 | |
| Corporate Director | Feb 28, 2022 | ||
| Gary M Ullery | Corporate Officer | Jan 1, 2024 | |
| Corporate Director | Jan 1, 2024 | ||
| BMH Inc | 5% Or Greater Direct Ownership Interest | Jul 1, 2007 | |
| Operational/Managerial Control | Jul 1, 2007 | ||
| Karalee Krehbiel | Corporate Officer | Feb 28, 2022 | |
| Corporate Director | Feb 28, 2022 | ||
| Linda Valentine | Corporate Director | Oct 1, 2017 |
Owners & managing parties with NPI records 8
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Medicare Defined Swing Bed Hospital Unit
- Blackfoot, ID
- NPI 1689876781
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba First Choice Urgent Care and Medical Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1922243088
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Critical Access Hospital
- Blackfoot, ID
- NPI 1982805271
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Idaho Physicians Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1770785875
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Bingham Memorial Skilled Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Blackfoot, ID
- NPI 1861694960
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Bingham Memorial Physicians & Surgeons Center
- Surgery Physician
- Blackfoot, ID
- NPI 1255539193
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Internal Medicine Physician
- Blackfoot, ID
- NPI 1164785382
Corporate Director, Corporate Officer
-
- Otolaryngology Physician
- Great Falls, MT
- NPI 1518101443
Corporate Director, Corporate Officer
All facility ownership & control disclosures 6
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Bingham Memorial Hospital | Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jun 8, 2007 Jun 8, 2007 |
| Bingham Memorial Hospital | Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control (100%) |
Jun 13, 2007 Jun 13, 2007 |
| Grove Creek Medical Center | Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2018 |
| Bingham Memorial Hospital | Skilled nursing facility | 5% Or Greater Direct Ownership Interest Operational/Managerial Control Adp of the SNF Direct Ownership Interest (100%) |
Jun 13, 2007 Jun 13, 2007 Jun 13, 2007 Jun 13, 2007 |
| Idaho Physicians Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jun 13, 2007 Jun 13, 2007 |
| First Choice Urgent Care & Medical Center | Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Mar 1, 2009 Mar 1, 2009 |
Owned or controlled facilities with NPI records 6
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Medicare Defined Swing Bed Hospital Unit
- Blackfoot, ID
- NPI 1689876781
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba First Choice Urgent Care and Medical Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1922243088
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Critical Access Hospital
- Blackfoot, ID
- NPI 1982805271
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Idaho Physicians Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1770785875
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Bingham Memorial Skilled Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Blackfoot, ID
- NPI 1861694960
5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control
-
dba Grove Creek Medical Center
- General Acute Care Hospital
- Blackfoot, ID
- NPI 1851371959
5% Or Greater Direct Ownership Interest
Facilities with the same owner 6
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba First Choice Urgent Care and Medical Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1922243088
BMH Inc
-
dba Idaho Physicians Clinic
- Rural Health Clinic/Center
- Blackfoot, ID
- NPI 1770785875
BMH Inc
-
dba Bingham Memorial Skilled Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Blackfoot, ID
- NPI 1861694960
BMH Inc
-
dba Grove Creek Medical Center
- General Acute Care Hospital
- Blackfoot, ID
- NPI 1851371959
BMH Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191888000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1613001600000",
"number": "1366630949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 W LOCUST ST",
"city": "SHELLEY",
"state": "ID",
"postal_code": "832741230",
"telephone_number": "208-782-2960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W LOCUST ST",
"city": "SHELLEY",
"state": "ID",
"postal_code": "832741230",
"telephone_number": "208-782-2960"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BMH INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BMH INC.",
"enumeration_date": "2007-10-09",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A",
"authorized_official_last_name": "ERICKSON",
"authorized_official_first_name": "JACOB",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "208-785-3801",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "ID",
"license": "36",
"primary": true
},
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807947000",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF IDAHO",
"identifier": "000010137702",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "8N304",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Physicians and Surgeons of Shelley",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Physicians and Surgeons of Shelley",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Shelley, ID
- Bingham Memorial Hospital (Bingham Memorial Physicians and Surgeons Clinic of Shelley)
- Suzanna Marie Bird
- Joshua Darwin Bischoff, DPT
- Blackfoot Medical Clinic, Inc
- Kenneth Todd Blackner, M.D.
- Nathan Bolander
- Samantha Ryleigh Brandt, DPT, PT
- Broulim Supermarkets, LLC (Broulim's Pharmacy #9 - Shelley)
- Chrystal Dawn Browning, PT, DPT, PCS
- Bryce D Hanson, DMD PA (River Valley Dental Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.