Carolyn Blasch, NURSE PRACTITIONER

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

8471548 Issued in ID

Practice address

161 E Mallard Dr Ste 120
Boise, ID 83706-5015

Phone

(208) 884-1333

NPI assigned

Jun 5, 2016

Last updated

Jan 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Carolyn Keller Former name

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

University of Cincinnati College of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Idaho Physical Medicine and Rehabilitation PAGroup PAC ID 3971579954, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Idaho Physical Medicine and Rehabilitation PA

  • Physical Medicine & Rehabilitation Physician
  • Meridian, ID
  • NPI 1497711329

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Idaho Physical Medicine and Rehabilitation PA

  • Ambulatory Surgical Clinic/Center
  • Meridian, ID
  • NPI 1497949705

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1465084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1992154538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3912 SAGE CREEK DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837145502",
            "telephone_number": "406-521-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 E MALLARD DR STE 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065015",
            "telephone_number": "208-884-1333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3551 E Overland Rd",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836426757",
            "country_code": "US",
            "telephone_number": "208-884-1333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLASCH",
        "first_name": "CAROLYN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-05",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ID",
            "license": "8471548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "KELLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Medina E Blanchet, RD
• Anne Blanchette, PA-C
• Zane Blank, MD
• Myree Blankenship, PSS
• Deleo A Blanks Benitez
• Alesha May Blaser
• Herbert Ray Blaser, DDS
• Ryan James Blaser, D.O.
• Travis Blaser, FNP
• Donald John Blaskiewicz, M.D.

• Physical Medicine & Rehabilitation Physician in Boise, ID
• Providers in Boise, ID by specialty
• Physical Medicine & Rehabilitation Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.