Active NPI
Preston Family Medicine
- Family Medicine Physician
- Preston, ID
National Provider Identifier
1891406112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- PRESTON FAMILY MEDICINE
- Practice address
- 43 N 1St E
Preston, ID 83263-1325 - Phone
- (423) 215-6465
- NPI assigned
- Dec 7, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gordon Scott Bontrager, MD
- Title
- Owner
- Phone
- (423) 215-6465
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
43 N 1St E
Preston, ID 83263-1325
Mailing address
43 N 1St E
Preston, ID 83263-1325
Phone (423) 215-6465
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780919829 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230307001343 | ID | Part B Supplier - Clinic/Group Practice | 6507239845 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment Practice locations: Preston, ID |
National Provider Directory
National Provider Directory- Tax ID family
- Bontrager Quick Care
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Urgent Care Clinic/Center
- Preston, ID
- NPI 1740989417
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Urgent Care Clinic/Center
- Preston, ID
- NPI 1740989417
O20230307001343
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Interventional Pain Medicine Physician
- Albuquerque, NM
- NPI 1184156630
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670371200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1677628800000",
"number": "1891406112",
"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": "423-215-6465"
},
{
"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": "423-215-6465"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRESTON FAMILY MEDICINE",
"organizational_subpart": "NO",
"enumeration_date": "2022-12-07",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A",
"authorized_official_last_name": "BONTRAGER",
"authorized_official_first_name": "GORDON",
"authorized_official_middle_name": "SCOTT",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "423-215-6465",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1780919829",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Preston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.