Michael PR Blair, FNP-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1361873 Issued in ID

Practice address

216 12TH Ave Rd
Nampa, ID 83686-5013

Phone

(208) 880-1928

NPI assigned

Apr 29, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Sep 13, 2024 through Sep 13, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1487400602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865013",
            "telephone_number": "208-880-1928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865013",
            "telephone_number": "208-880-1928"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16675 Old Friendship Way",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836071467",
            "country_code": "US",
            "telephone_number": "208-272-0326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "MICHAEL",
        "middle_name": "PR",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-08-27",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "ID",
            "license": "N-45980",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "1361873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austinn Elise Black
• Randall A Black, D.O.
• Stuart Black, M.D.
• Chris Blaine
• Callie Rose Blair, D.O.
• Teresa L Blair, CNM - WHNP
• Leah Janine Blake
• Amanda Rose Bledsoe, FNP-C
• Olivia Nilda Blom
• Bloom Coordination, LLC

• All providers in Nampa, ID
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.