Bruce E. Gollub, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-17332 Issued in ID

Practice address

775 Pole Line Rd W Ste 103
Twin Falls, ID 83301-5819

Phone

(208) 814-8375

Fax

(208) 814-8376

NPI assigned

Oct 18, 2005

Last updated

Nov 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

University of Missouri, Columbia School of Medicine, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ketchum Family Medicine, PLLCGroup PAC ID 7113347717, 2 clinicians

St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
• St Luke's Wood River Medical Center Hospital, Ketchum, ID, CCN 131323

Merit-based Incentive Payment System (MIPS)

Final score

85.09 of 100Reported as group

Quality

77.1

Promoting interoperability

100

Improvement activities

40

Cost

73.19

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bruce.gollub.1@25701.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/25701/brand/1/csg/1/fhir/r4

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.

• Ketchum Family Medicine, PLLC

  • Family Medicine Physician
  • Ketchum, ID
  • NPI 1720692650
  Medicare reassignment Care Compare group NPD
• St Luke's Clinic LLC

  dba St Lukes Clinic - Magic Valley/Jerome

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229
  Medicare reassignment Care Compare group NPD
• Isis Medicine PC

  • Medical Physician Assistant
  • Santa Fe, NM
  • NPI 1114996188
  NPD
• Nancy Parry MD,PC

  • Family Medicine Physician
  • Ketchum, ID
  • NPI 1396953824
  NPD (past)
• St Luke's Magic Valley Regional Medical Center LTD

  dba St Lukes Retail Pharmacy Twin Falls

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Lukes Wood River Medical Center LTD

  dba St Lukes Wood River Medical Center

  • Critical Access Hospital
  • Ketchum, ID
  • NPI 1508869470
  Care Compare affiliation
• St. Luke's Magic Valley Regional Medical Center, LTD.

  dba St Lukes Magic Valley - Air Ambulance

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1508855917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 103",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015819",
            "telephone_number": "208-814-8375",
            "fax_number": "208-814-8376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Botulph Ln",
            "address_purpose": "LOCATION",
            "city": "Santa Fe",
            "state": "NM",
            "postal_code": "875056912",
            "country_code": "US",
            "telephone_number": "505-983-8387",
            "fax_number": "505-820-2733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "660 2nd Ave. S. Apt A",
            "address_purpose": "LOCATION",
            "city": "Ketchum",
            "state": "ID",
            "postal_code": "83340",
            "country_code": "US",
            "telephone_number": "208-622-3180",
            "fax_number": "833-795-1981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLLUB",
        "first_name": "BRUCE",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "80-158",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-17332",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NM",
            "license": "80-158",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22491",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greg B Godfrey, D.D.S.
• Melissa Goeckner
• Jaime Rae Goffin, LCSW, CADCI
• Geoffroi Andre Golay, D.C.
• Jacqueline Golay, LMSW
• Samantha Gonzales, FNP-C
• Erin Goodfellow, NURSE PRACTITIONER
• Gooding Pharmacy Inc (R and R Pharmacy Twin Falls)
• Gooding Pharmacy Inc (R&R Pharmacy - Twin Falls LTC)
• Mason Goodman

• Family Medicine Physician in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; 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.

Verify at the official NPI Registry.