Blue Mountain Family Health PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00045393 Issued in WA

Legal business name

BLUE MOUNTAIN FAMILY HEALTH PLLC

Practice address

1268 Bridge St
Clarkston, WA 99403-2219

Phone

(509) 751-5500

Fax

(509) 751-1059

NPI assigned

Nov 27, 2006

Organization subpart

No

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

Authorized official

Name

Kevin James Black

Title

Administrator

Phone

(509) 751-5500

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Blue Mountain Family Health Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBCDAA

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Lefft Black, MD

  • Family Medicine Physician
  • Clarkston, WA
  • NPI 1578556833

  Family Medicine, WA

  Medicare reassignment Care Compare group NPD
• Stephanie Margaret Carpenter, PMHNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Lewiston, ID
  • NPI 1629329537

  WA

  Medicare reassignment Care Compare group NPD
• Todd M Carpenter, NP

  • Family Nurse Practitioner
  • Clarkston, WA
  • NPI 1255629267
  NPD

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1679649248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1268 BRIDGE ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032219",
            "telephone_number": "509-751-5500",
            "fax_number": "509-751-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 BRIDGE ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032219",
            "telephone_number": "509-751-5500",
            "fax_number": "509-751-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MOUNTAIN FAMILY HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-751-5500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00045393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7130354",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807278700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80745000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8439333",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Mountain Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amelia Bieniek
• Nicole Marie Bishop
• Bonnie R Black, SOCIAL WORKER
• Elizabeth Lefft Black, MD
• Jacob I. Blazzard, PA-C
• Jace Blume
• Trudy Bly, RN,CDE
• Herbert Bohner, RPH
• Maggie Rosalie Bolon, LCSW
• Chad Ryan Bouterse, D.O.

• All providers in Clarkston, WA
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.