NPIMap

Organization Active NPI

MVH BMC LLC

Doing business as Shelley Family Medical Center

  • Family Medicine Physician
  • Rexburg, ID
National Provider Identifier
1649699216
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
Shelley Family Medical Center
Practice address
37 S 2ND E
Rexburg, ID 83440-1906
Phone
(208) 356-0234
NPI assigned
Apr 10, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

37 S 2ND E
Rexburg, ID 83440-1906

Mailing address

210 S Emerson Ave
Shelley, ID 83274-1229
Phone (208) 357-7404

Other names 1

  • Shelley Family 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
This NPI is an additional NPI on the enrollment
Practice locations: Blackfoot, ID; Shelley, ID

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
MVH BMC LLC3 organizations share this tax ID, including this one
Part of
Mountain View Hospital Physician Organization

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

  • MVH BMC LLC

    dba Blackfoot Medical Center

    • Rural Health Clinic/Center
    • Blackfoot, ID
    • NPI 1467816579
    NPD tax ID
  • MVH BMC LLC

    dba Shelley Family Medical Center

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1649699216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S EMERSON AVE",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741229",
            "telephone_number": "208-357-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 S 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401906",
            "telephone_number": "208-356-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MVH BMC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN VIEW HOSPITAL",
        "enumeration_date": "2014-04-10",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelley Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rexburg, 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.