NPIMap

Individual provider Active NPI

Gordon Scott Bontrager, MD

  • Family Medicine Physician
  • Preston, ID
National Provider Identifier
1780919829
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MRM-1734 Issued in ID
Practice address
43 N 1St E
Preston, ID 83263-1325
Phone
(208) 648-4771
Fax
(208) 744-0140
NPI assigned
Oct 7, 2009
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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 MRM-1734 ID Primary
Physician Assistant 363A00000X 2119 TN

Addresses

Primary practice location

43 N 1St E
Preston, ID 83263-1325

Mailing address

43 N 1St E
Preston, ID 83263-1325
Phone (208) 648-4771

Other practice location 1

44 N 1st E
Preston, ID 83263-1326
Phone (208) 648-4771

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
I20201211001838 ID Practitioner - Family Practice 4486792769 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
East Tennessee State University Quillen College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Preston Family MedicineGroup PAC ID 6507239845, 2 clinicians

Practice addresses (Care Compare)

44 N 1St
Preston, ID 83263-1326
Phone (208) 648-4771

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MRM-1734IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Preston Drug Health Services LLC Family Medicine CurrentSince Oct 3, 2023 Accepting new patients
Franklin County Medical Center CurrentSince Apr 10, 2022 Accepting new patients
Franklin County Medical Center Family Medicine CurrentSince Apr 10, 2022 Accepting new patients
Preston Family Medicine Dba Bontrager Quick Care CurrentSince Nov 28, 2022 Accepting new patients
Preston Family Medicine Family Medicine CurrentSince Nov 28, 2022 Accepting new patients

Locations

39 N 1st E
Preston, ID 83263
Phone (208) 851-1561

43 N 1st E
Preston, ID 83263
Phone (208) 648-4771

44 N 1st E
Preston, ID 83263
Phone (208) 852-0137

300 S 3rd W
Soda Springs, ID 83276
Phone (208) 547-0700

Interoperability endpoints

  • Direct secure messaging: gordon.bontrager.1@17373.direct.athenahealth.com
  • Direct secure messaging: gordon.bontrager@541628922265604.direct.elationemr.com

Organizations & group practices 5

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 3

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": "1254873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1780919829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 N 1ST E",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631325",
            "telephone_number": "208-648-4771",
            "fax_number": "208-744-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 N 1ST E",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631325",
            "telephone_number": "208-648-4771",
            "fax_number": "208-744-0140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44 N 1st E",
            "address_purpose": "LOCATION",
            "city": "Preston",
            "state": "ID",
            "postal_code": "832631326",
            "country_code": "US",
            "telephone_number": "208-648-4771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONTRAGER",
        "first_name": "GORDON",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-07",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-1734",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2119",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Preston, ID

Sources for this page

Verify at the official NPI Registry.