NPIMap

Individual provider Active NPI

Harrison Davis Blanton, MD

  • Family Medicine Physician
  • Caldwell, ID
National Provider Identifier
1689932659
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR0053011 Issued in CO
Practice address
315 E Elm Street
Ste 100
Caldwell, ID 83605-4858
Phone
(208) 302-7100
Fax
(208) 302-7155
NPI assigned
Apr 27, 2012
Last updated
Jul 31, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-12857 ID
Family Medicine Physician 207Q00000X DR0053011 CO Primary

Addresses

Primary practice location

315 E Elm Street
Ste 100
Caldwell, ID 83605-4858

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 302-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20180918002035 CO Practitioner - Family Practice 6204078421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Brody School of Medicine at East Carolina University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Health Care IncGroup PAC ID 7618880709, 56 clinicians

Practice addresses (Care Compare)

1024 S Lemay Ave
Fort Collins, CO 80524-3929
Phone (970) 495-7127

1025 Pennock PL
Fort Collins, CO 80524-3250

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR0053011COMDFamily Medicine Physician
M-12857IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Health Care Inc. Current Accepting new patients
Poudre Valley Health Care Inc CurrentSince Oct 8, 2018 Accepting new patients
Poudre Valley Health Care,Inc Past Accepting new patients

Locations

1025 Pennock Pl
Fort Collins, CO 80524
Phone (970) 495-8800

1025 Pennock Pl
Ste 114
Fort Collins, CO 80524
Phone (970) 495-8800

2315 E Harmony Rd
Ste 200
Fort Collins, CO 80528

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 3

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1689932659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-7100",
            "fax_number": "208-302-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E ELM STREET",
            "address_2": "STE 100",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054858",
            "telephone_number": "208-302-7100",
            "fax_number": "208-302-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANTON",
        "first_name": "HARRISON",
        "middle_name": "DAVIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-27",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-12857",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR0053011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

Verify at the official NPI Registry.