NPIMap

Organization Active NPI

MVH BMC LLC

Doing business as Blackfoot Medical Center

  • Family Medicine Physician
  • Blackfoot, ID
National Provider Identifier
1649699174
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MVH BMC LLC
Doing business as
Blackfoot Medical Center
Practice address
1441 Parkway Dr
Blackfoot, ID 83221-1667
Phone
(208) 785-2600
NPI assigned
Apr 14, 2014
Last updated
Apr 21, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAIN VIEW HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Mr. Ned Hillyard
Title
Chief Compliance Officer
Phone
(208) 557-2711

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Urgent Care Clinic/Center 261QU0200X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1441 Parkway Dr
Blackfoot, ID 83221-1667

Mailing address

1441 Parkway Dr
Blackfoot, ID 83221-1667
Phone (208) 785-2600

Other names 1

  • Blackfoot Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160608002399 ID Part B Supplier - Clinic/Group Practice 2961791991 Receives reassigned benefits from 41 practitioners
1 other NPI on this enrollment
Practice locations: Blackfoot, ID; Shelley, ID

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • MVH BMC LLC

    dba Blackfoot Medical Center

    • Rural Health Clinic/Center
    • Blackfoot, ID
    • NPI 1467816579

    2961791991

    Same PAC ID
  • MVH BMC LLC

    dba Shelley Family Medical Center

    • Rural Health Clinic/Center
    • Shelley, ID
    • NPI 1700206588

    2961791991

    Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

  • MVH BMC LLC

    dba Shelley Family Medical Center

    • Family Medicine Physician
    • Rexburg, ID
    • NPI 1649699216

    O20160608002399

    Same enrollment

National Provider Directory

National Provider Directory
Part of
Idaho Falls Pulmonary

Locations

380 Walker Dr
Rexburg, ID 83440
Phone (208) 356-9559

450 E Main St
Fl 2
Rexburg, ID 83440

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1649699174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211667",
            "telephone_number": "208-785-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211667",
            "telephone_number": "208-785-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MVH BMC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN VIEW HOSPITAL",
        "enumeration_date": "2014-04-14",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "HILLYARD",
        "authorized_official_first_name": "NED",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "208-557-2711",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackfoot Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.