Individual provider Active NPI

Samuel Welling Beckstead, DO

  • Ophthalmology Physician
  • Chubbuck, ID
National Provider Identifier
1487041380
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
O-1389 Issued in ID
Practice address
5620 Harvest Springs Blvd
Chubbuck, ID 83202-1061
Phone
(208) 232-4133
Fax
(208) 529-6602
NPI assigned
Apr 20, 2015
Last updated
Aug 12, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X O-1389 ID
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X O-1389 ID Primary

Addresses

Primary practice location

5620 Harvest Springs Blvd
Chubbuck, ID 83202-1061

Mailing address

2100 Providence Way
Idaho Falls, ID 83404-4951
Phone (082) 529-6600

Other practice location 1

2100 Providence Way
Idaho Falls, ID 83404-4951
Phone (208) 529-6600

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
I20200904001782 ID Practitioner - Ophthalmology 5395038681 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Eye Care of Eastern IdahoGroup PAC ID 2466611744, 11 clinicians

Practice addresses (Care Compare)

2100 Providence Way
Idaho Falls, ID 83404-4951
Phone (208) 529-6600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.96 of 100Reported as group
Quality
100
Improvement activities
40
Cost
76.54

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery94
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-1389IDMDOphthalmic Plastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Eye Care of Eastern Idaho Multi-Specialty CurrentSince Oct 5, 2020 Accepting new patients
Charles P. Lawless, M.D., P.a. Multi-Specialty PastSince Jan 2, 1997 Accepting new patients

Locations

5620 Harvest Springs Blvd
Chubbuck, ID 83202
Phone (208) 232-4133

2100 Providence Way
Idaho Falls, ID 83404
Phone (208) 529-6600

1777 E Clark St
Ste 310
Pocatello, ID 83201
Phone (208) 232-4133

Interoperability endpoints

  • Direct secure messaging: sbeckstead354566@ahs.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1487041380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 PROVIDENCE WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044951",
            "telephone_number": "082-529-6600",
            "fax_number": "208-529-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 HARVEST SPRINGS BLVD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832021061",
            "telephone_number": "208-232-4133",
            "fax_number": "208-529-6602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Providence Way",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834044951",
            "country_code": "US",
            "telephone_number": "208-529-6600",
            "fax_number": "208-529-6602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BECKSTEAD",
        "first_name": "SAMUEL",
        "middle_name": "WELLING",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-20",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "ID",
            "license": "O-1389",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "O-1389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chubbuck, ID

Sources for this page

Verify at the official NPI Registry.