NPIMap

Individual provider Active NPI

Ricky Dwayne Latham, MD

  • Cardiovascular Disease Physician
  • Idaho Falls, ID
National Provider Identifier
1477553139
Registry record updated Feb 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD170342 Issued in OR
Practice address
2001 Valenica Drive
Suite 201
Idaho Falls, ID 83404
Phone
(208) 524-9400
Fax
(208) 524-9401
NPI assigned
Jul 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X M6887 ID
Cardiovascular Disease Physician 207RC0000X MD170342 OR Primary

Addresses

Primary practice location

2001 Valenica Drive
Suite 201
Idaho Falls, ID 83404

Mailing address

1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone (541) 266-4650

Other identifiers 14

IdentifierTypeStateIssuer
111489100OtherMEDICAID WYOMING, MWY
000010005099OtherBLUE SHIELD OF ID, BS
060053550OtherRAILROAD MEDICARE, RRM
DZ692OtherBLUE CROSS OF ID SE, BC2
M6887OtherIDID
000010005099OtherBLUE SHIELD OF ID S, BS2
000353200OtherEDS- MEDICAID, EDS
111489100OtherWY/EDS CONSULTEC, INC WYM
8318842OtherMEDICAID OF WA, MD-W
DZ692OtherBLUE CROSS OF IDAHO, BC
000353200MedicaidID
500680039MedicaidOR
0031512OtherMONTANA MEDICAID, MEM
1134041OtherMEDICARE-CIGNA, MC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040507000103 ID Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 0446249387 Reassigns benefits to 3 organizations
I20150207000423 OR Practitioner - Cardiovascular Disease (Cardiology) 0446249387 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Internal Medicine
Education
Louisiana State University School of Medicine in Shreveport, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
BMH IncGroup PAC ID 8426149758, 137 clinicians
Bingham Memorial HospitalGroup PAC ID 8426955014, 68 clinicians

Practice addresses (Care Compare)

1151 Hospital Way
Pocatello, ID 83201-5091
Phone (208) 239-8008

315 W Idaho St
Blackfoot, ID 83221-1711
Phone (208) 782-3990

4742 Yellowstone Ave
Pocatello, ID 83202-2336
Phone (208) 251-0316

4750 Yellowstone Ave
Pocatello, ID 83202-2336
Phone (208) 233-1720

850 Yellowstone Ave
Pocatello, ID 83201-4415
Phone (208) 239-8065

98 Poplar St
Blackfoot, ID 83221-1758
Phone (208) 785-4100

Hospital & facility affiliations

  • Bingham Memorial Hospital Hospital, Blackfoot, ID, CCN 131325
  • Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018
  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028
  • Caribou Medical Center Hospital, Soda Springs, ID, CCN 131309

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M6887IDMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mark'S Professional Services, LLC Internal Medicine CurrentSince Mar 31, 2018 Accepting new patients
BMH Inc CurrentSince Dec 1, 2017 Accepting new patients
Bay Area Hospital District CurrentSince Jan 1, 2016 Accepting new patients
Bay Area Hospital District CurrentSince Jan 1, 2016 Accepting new patients
BMH, Inc. Cardiovascular Disease CurrentSince Dec 1, 2017 Accepting new patients
BMH, Inc. Internal Medicine Current Accepting new patients
BMH, Inc. CurrentSince Dec 1, 2017 Accepting new patients
Eastern Idaho Cardiology Associates, PLLC Cardiovascular Disease PastSince Apr 30, 2003 Accepting new patients
Fairbanks Memorial Cardiology Center Cardiovascular Disease Past Accepting new patients
Fairbanks Memorial Cardiology Center, LLC Past Accepting new patients
BMH Inc. Past Accepting new patients
Radial First Holdings Interventional Cardiology Past Accepting new patients

Locations

Dept LA 25339
Pasadena, CA 91185

98 Poplar St
Blackfoot, ID 83221
Phone (208) 782-3763

235 Poplar St
Blackfoot, ID 83221
Phone (208) 785-3828

315 W Idaho St
Blackfoot, ID 83221
Phone (208) 782-3990

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

3302 Valencia Dr
Ste 201
Idaho Falls, ID 83404
Phone (208) 524-9400

3100 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2100

1151 Hospital Way
#D100
Pocatello, ID 83201
Phone (208) 239-8010

850 Yellowstone Ave
Ste B
Pocatello, ID 83201
Phone (208) 239-8066

1151 Hospital Way
Ste D100
Pocatello, ID 83201

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

1775 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-8090

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5838/brand/1/csg/1/fhir/r4
  • Direct secure messaging: rickylatham@bmh.medalliesdirect.net

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 6

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": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550016000000",
    "number": "1477553139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202125",
            "telephone_number": "541-266-4650",
            "fax_number": "541-266-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VALENICA DRIVE",
            "address_2": "SUITE 201",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-524-9400",
            "fax_number": "208-524-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "RICKY",
        "middle_name": "DWAYNE",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2019-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ID",
            "license": "M6887",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD170342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WYOMING, MWY",
            "identifier": "111489100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ID, BS",
            "identifier": "000010005099",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE, RRM",
            "identifier": "060053550",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID SE, BC2",
            "identifier": "DZ692",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID",
            "identifier": "M6887",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ID S, BS2",
            "identifier": "000010005099",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS- MEDICAID, EDS",
            "identifier": "000353200",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY/EDS CONSULTEC, INC WYM",
            "identifier": "111489100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OF WA, MD-W",
            "identifier": "8318842",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO, BC",
            "identifier": "DZ692",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000353200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500680039",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA MEDICAID, MEM",
            "identifier": "0031512",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-CIGNA, MC",
            "identifier": "1134041",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.