NPIMap

Individual provider Active NPI

John Douglas Trueblood, PAC

  • Physician Assistant
  • Cottonwood, ID
National Provider Identifier
1629047931
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1623 Issued in ID
Practice address
701 Lewiston Street
Cottonwood, ID 83522
Phone
(208) 962-3267
Fax
(208) 962-3722
NPI assigned
Mar 17, 2006
Last updated
Aug 16, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA16906 CA
Physician Assistant 363A00000X PA1623 ID Primary

Addresses

Primary practice location

701 Lewiston Street
Cottonwood, ID 83522

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 962-3251

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190218003086 ID Practitioner - Physician Assistant 8820096332 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Hospital IncGroup PAC ID 5092773168, 22 clinicians

Practice addresses (Care Compare)

501 Oak St
Nezperce, ID 83543-5064
Phone (208) 937-2496

701 Lewiston St
Cottonwood, ID 83522-9750
Phone (208) 962-3251

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
16906CAMDAcupuncturist
PA16906CAMDPhysician Assistant
PA1623IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital Inc Current Accepting new patients
St. Mary's Hospital Inc CurrentSince Jan 15, 2019 Accepting new patients
St. Mary's Hospital Inc CurrentSince Jan 15, 2019 Accepting new patients
St. Mary's Hospital Inc Current Accepting new patients
Medflow PC Past Accepting new patients
Clearwater Valley Hospital & Clinics Inc. Physician Assistant Past Accepting new patients

Locations

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

701 Lewiston St
Cottonwood, ID 83522
Phone (208) 962-3251

320 N Division Ave
Craigmont, ID 83523
Phone (208) 924-5504

501 Oak St
Nezperce, ID 83543
Phone (208) 937-2496

301 Cedar St
Orofino, ID 83544
Phone (208) 476-4555

Interoperability endpoints

  • Direct secure messaging: johntrueblood@smhcvh.medalliesdirect.net
  • Direct secure messaging: johntrueblood@smhcvhc.medalliesdirect.net

Organizations & group practices 6

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 11

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1629047931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-962-3251",
            "fax_number": "208-962-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 LEWISTON STREET",
            "city": "COTTONWOOD",
            "state": "ID",
            "postal_code": "83522",
            "telephone_number": "208-962-3267",
            "fax_number": "208-962-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUEBLOOD",
        "first_name": "JOHN",
        "middle_name": "DOUGLAS",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16906",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA1623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, ID

Sources for this page

Verify at the official NPI Registry.