James Wallentine Blotter, M.D.
Individual provider Active NPI Plastic Surgery within the Head & Neck (Otolaryngology) Physician · North Logan, UT
NPI 1962499673 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1962499673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X
- License
- 3082587-1205 (UT)
- Practice address
- 2245 N 400 E
Ste 301
North Logan, UT 84341-1892 - Phone
- (435) 753-7880
- Fax
- (435) 753-5845
- NPI assigned
- Sep 29, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- University of Utah School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cache Valley Ear Nose and Throat, PLLC
Practice addresses (Care Compare)
164 S 5TH St
Montpelier, ID 83254-1557
Phone (435) 753-7880
169 N Gateway Dr
Suite 120
Providence, UT 84332-9728
Phone (435) 753-7880
Hospital & facility affiliations
- Intermountain Health Logan Regional Hospital
- Bear Lake Memorial Hospital
- Cache Valley Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100831000194 | UT | Practitioner - Otolaryngology |
4587739149 | Reassigns benefits to 1 organization |
| I20220221001256 | ID | Practitioner - Otolaryngology | 4587739149 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery within the Head & Neck (Otolaryngology) Physician | 207YX0007X | 3082587-1205 | UT | Yes |
Addresses
Primary practice location
2245 N 400 E
Ste 301
North Logan, UT 84341-1892
Mailing address
2245 N 400 E
Ste 301
North Logan, UT 84341-1892
Phone (435) 753-7880
Other practice location 1
2380 N 400 E
Suite #D
North Logan, UT 84341-1749
Phone (435) 753-7880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M-8784 | Other | ID | IDAHO STATE LICENSE |
| 87037196400 | Medicaid | UT |
Other providers in North Logan, UT
- Jeffrey Call Baugh
- Bear Lake Community Health Center, Inc.
- Jeffrey Green Bennion
- Caitlin Sayard Benvenuti
- Bradley Pope Bills
- Andrea Ellis Bott
- Paul Tucker Bradley
- Bright Sage Psychology LLC
- Bruce Lundin OD LLC
- Cedric Buckley
All providers in North Logan, UT · Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.