Gustin Ross Blad, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP-1143A Issued in ID

Practice address

777 Hospital Way
Pocatello, ID 83201-5175

Phone

(208) 239-1000

NPI assigned

Mar 8, 2012

Last updated

Mar 8, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028
• Bear Lake Memorial Hospital Hospital, Montpelier, ID, CCN 131316
• Nell J Redfield Memorial Hospital Hospital, Malad City, ID, CCN 131303
• Caribou Medical Center Hospital, Soda Springs, ID, CCN 131309
• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gblad178707@ahs.direct-ci.com

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.

• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1689802852
  Medicare reassignment Care Compare group NPD
• Heritage Physician and Resource Group LLC

  • General Practice Physician
  • Pocatello, ID
  • NPI 1962896027
  Medicare reassignment NPD
• Pocatello Health Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pocatello, ID
  • NPI 1154089126
  NPD
• Pocatello Health Services, LLC

  dba Portneuf Medical Practices

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1215165485
  NPD
• Pocatello Hospital LLC

  • Internal Medicine Physician
  • Pocatello, ID
  • NPI 1760610935
  NPD (past)
• Cache Valley Vein

  • Vascular & Interventional Radiology Physician
  • Providence, UT
  • NPI 1831662311
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bear Lake County Memorial Hospital

  • Critical Access Hospital
  • Montpelier, ID
  • NPI 1336125533
  Care Compare affiliation
• Caribou Medical Center, Inc

  dba Caribou Medical Center

  • Critical Access Hospital
  • Soda Springs, ID
  • NPI 1942970272
  Care Compare affiliation
• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation
• Oneida County Hospital

  • Critical Access Hospital
  • Malad, ID
  • NPI 1609826270
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1982979936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAD",
        "first_name": "GUSTIN",
        "middle_name": "ROSS",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-08",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1143A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Grant Black, PT
• Melanie Blackburn
• Blackrock Counseling
• Blackrock Dental Partners, PLLC (Blackrock Dental)
• Carol Blackwell, PHARMD
• James L Blaine, P.A.-C
• Benjamin Blair, MD
• Blake D. Alexander, MD, PA
• Katrina D Blake, LMT
• Brooke Leigh Blanchard, COTA

• Family Nurse Practitioner in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.