Individual provider Active NPI

Guss Grimmett, NP

  • Nurse Practitioner
  • Blackfoot, ID
National Provider Identifier
1881620730
Registry record updated Apr 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP-651 Issued in ID
Practice address
1441 Parkway Dr
Blackfoot, ID 83221-1667
Phone
(208) 785-2600
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP-651 ID Primary

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 identifiers 1

IdentifierTypeStateIssuer
806949500MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041002000031 ID Practitioner - Nurse Practitioner 7214906577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MVH BMC LLCGroup PAC ID 2961791991, 14 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-651IDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MVH BMC LLC Nurse Practitioner CurrentSince May 1, 2016 Accepting new patients
MVH BMC LLC CurrentSince May 1, 2016 Accepting new patients
Pocatello Health Services, LLC Past Accepting new patients

Locations

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

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

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

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492041600000",
    "number": "1881620730",
    "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": {
        "last_name": "GRIMMETT",
        "first_name": "GUSS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2017-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP-651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806949500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, ID

Sources for this page

Verify at the official NPI Registry.