Active NPI
Nicholas Blickenstaff, M.D., M.S.
- Dermatology Physician
- Boise, ID
National Provider Identifier
1437544582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- M15699
- Practice address
- 6454 W Emerald St
Boise, ID 83704-8734 - Phone
- (208) 377-0820
- Fax
- (208) 375-8046
- NPI assigned
- Apr 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 036.150002 | IL | |
| Dermatology Physician | 207N00000X | M15699 | ID | Primary |
Addresses
Primary practice location
6454 W Emerald St
Boise, ID 83704-8734
Mailing address
7123 W Archer Ave
Chicago, IL 60638-2203
Phone (708) 634-4602
Other practice location 1
13176 W Persimmon Ln
Boise, ID 83713-5063
Phone (208) 939-8640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- University of Utah School of Medicine, 2019
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
6454 W Emerald St
Boise, ID 83704-8734
Phone (208) 377-0820
Hospital & facility affiliations
- St Luke'S Regional Medical Center
- Saint Alphonsus Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.97 of 100
- Quality
- 74.91
- Improvement activities
- 40
- Cost
- 96.7
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 241 |
| Removal of skin lesions | 1350 |
| Removal or shaving of skin growth | 59 |
| Skin biopsy | 339 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M15699 | ID | MD | Dermatology Physician |
| 036.150002 | IL | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ada Dermatology, P.a. | Single Specialty | Current | Accepting new patients |
| Dermatology and Plastic Surgery Associates, S.C. | Single Specialty | Past | Accepting new patients |
| Jan Deblieck MD PA | Single Specialty | Past | Accepting new patients |
Locations
13176 W Persimmon Ln
Boise, ID 83713
Phone (208) 939-5030
6454 W Emerald St
Boise, ID 83704
Phone (208) 377-0820
Interoperability endpoints
- nblickenstaff@directaddress.net
Organizations & group practices 4
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.
-
- Procedural Dermatology Physician
- Joliet, IL
- NPI 1700987328
Single Specialty
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Boise, ID
- NPI 1184155426
-
- General Acute Care Hospital
- Boise, ID
- NPI 1457414948
-
- Psychiatric Hospital Unit
- Boise, ID
- NPI 1770687857
-
- Family Medicine Physician
- Caldwell, ID
- NPI 1861676298
Hospital
-
- General Acute Care Hospital
- Boise, ID
- NPI 1992736649
-
- General Acute Care Hospital
- Boise, ID
- NPI 1770586794
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650844800000",
"number": "1437544582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7123 W ARCHER AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606382203",
"telephone_number": "708-634-4602",
"fax_number": "630-495-1770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6454 W EMERALD ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837048734",
"telephone_number": "208-377-0820",
"fax_number": "208-375-8046"
}
],
"practiceLocations": [
{
"address_1": "13176 W Persimmon Ln",
"address_purpose": "LOCATION",
"city": "Boise",
"state": "ID",
"postal_code": "837135063",
"country_code": "US",
"telephone_number": "208-939-8640",
"fax_number": "208-939-1892",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLICKENSTAFF",
"first_name": "NICHOLAS",
"credential": "M.D., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-04",
"last_updated": "2022-04-25",
"certification_date": "2022-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "IL",
"license": "036.150002",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "ID",
"license": "M15699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; 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.