NPIMap

Individual provider Active NPI

Kami Crnich Bellomy, FNP-C

  • Family Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1952852642
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
54164 Issued in ID
Practice address
1159 E Iron Eagle Dr
Suite 170D
Eagle, ID 83616-6871
Phone
(208) 514-0670
Fax
(208) 549-7880
NPI assigned
Oct 18, 2016
Last updated
Oct 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 54164 ID Primary

Addresses

Primary practice location

1159 E Iron Eagle Dr
Suite 170D
Eagle, ID 83616-6871

Mailing address

1159 E Iron Eagle Dr
Suite 170D
Eagle, ID 83616-6871
Phone (208) 514-0670

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
I20161121000109 ID Practitioner - Nurse Practitioner 9739468471 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Key Stone Health CareGroup PAC ID 0648402784, 6 clinicians
Keystone Center for Geriatrics LLCGroup PAC ID 7618365792, 8 clinicians

Practice addresses (Care Compare)

21 N Fisher Park Way
Eagle, ID 83616-4796
Phone (208) 514-0670

305 W Bannock St
Boise, ID 83702-6033
Phone (208) 514-0670

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54164IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Center for Geriatrics LLC CurrentSince Nov 1, 2021 Accepting new patients
Key Stone Health Care CurrentSince Oct 9, 2016 Accepting new patients
Keystone Hospice, LLC PastSince Aug 11, 2019 Accepting new patients

Locations

305 W Bannock St
Boise, ID 83702
Phone (208) 514-0670

1159 E Iron Eagle Dr
Ste 170
Eagle, ID 83616
Phone (208) 209-3242

1159 E Iron Eagle Dr
Ste 170D
Eagle, ID 83616
Phone (208) 209-3242

21 N Fisher Park Way
Eagle, ID 83616
Phone (208) 514-0670

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 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": "1476748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1952852642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1159 E IRON EAGLE DR",
            "address_2": "SUITE 170D",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166871",
            "telephone_number": "208-514-0670",
            "fax_number": "208-549-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 E IRON EAGLE DR",
            "address_2": "SUITE 170D",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166871",
            "telephone_number": "208-514-0670",
            "fax_number": "208-549-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLOMY",
        "first_name": "KAMI",
        "middle_name": "CRNICH",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "54164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.