| Community Care Pocatello | |
|
1595 Yellowstone Ave Pocatello ID 83201-4203 | |
| (208) 233-0032 | |
| Not Available |
| Full Name | Community Care Pocatello |
|---|---|
| Speciality | Family Medicine |
| Location | 1595 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Joshua Tolman (CAO) |
| Authorized Official Contact | 2085572700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Pocatello 2325 Coronado St Idaho Falls ID 83404-7407 Ph: (208) 557-2700 | Community Care Pocatello 1595 Yellowstone Ave Pocatello ID 83201-4203 Ph: (208) 233-0032 |
| NPI Number | 1538517156 |
|---|---|
| Provider Enumeration Date | 05/25/2016 |
| Last Update Date | 05/25/2016 |
| Medicare PECOS PAC ID | 8527353176 |
|---|---|
| Medicare Enrollment ID | O20160822003018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538517156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gordon E Dixon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578518395 PECOS PAC ID: 3274442116 Enrollment ID: I20040929000890 |
| Provider Name | Trevor R Bartlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639442973 PECOS PAC ID: 1456515840 Enrollment ID: I20120615000028 |
| Provider Name | Scott Bradley Schaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720410012 PECOS PAC ID: 2961620620 Enrollment ID: I20140821002846 |
| Provider Name | Jamie L Gudmunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669853719 PECOS PAC ID: 3971816448 Enrollment ID: I20150714000351 |
| Provider Name | Patricia Stadler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124569108 PECOS PAC ID: 0446537526 Enrollment ID: I20170426002519 |
| Provider Name | Mark E Lupton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134579576 PECOS PAC ID: 9133492242 Enrollment ID: I20170911002657 |
| Provider Name | Devn A Frandsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730316043 PECOS PAC ID: 9032344064 Enrollment ID: I20180504001917 |
| Provider Name | Zachary M Buck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871023135 PECOS PAC ID: 3577832302 Enrollment ID: I20190131002816 |
| Provider Name | Hailey Anne Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487125969 PECOS PAC ID: 8921348129 Enrollment ID: I20190326002408 |
| Provider Name | Tina Scoggins |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1689037129 PECOS PAC ID: 3375882988 Enrollment ID: I20191030002281 |
| Provider Name | Rebekah M Lucero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285295634 PECOS PAC ID: 3779915582 Enrollment ID: I20191118000040 |
| Provider Name | Chance D Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841784535 PECOS PAC ID: 6305194770 Enrollment ID: I20200612000768 |
| Provider Name | Benjamin Leishman |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1063862977 PECOS PAC ID: 3375839517 Enrollment ID: I20200707002607 |
| Provider Name | Brandon Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255947255 PECOS PAC ID: 0143633297 Enrollment ID: I20210108001296 |
| Provider Name | Jordan Forbush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821680166 PECOS PAC ID: 5496154684 Enrollment ID: I20210519003174 |
| Provider Name | Annette Mary Tuft |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255005104 PECOS PAC ID: 1557759743 Enrollment ID: I20211020001536 |
| Provider Name | Roberta Bostian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972275501 PECOS PAC ID: 4385037514 Enrollment ID: I20220210000411 |
| Provider Name | Tim Robert Schuijt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801550553 PECOS PAC ID: 7113312620 Enrollment ID: I20220321000782 |
| Provider Name | Monique Catron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952066177 PECOS PAC ID: 9537555412 Enrollment ID: I20220331002409 |
| Provider Name | Stephanie Ann Orr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285392720 PECOS PAC ID: 6002046901 Enrollment ID: I20220414002130 |
| Provider Name | Jenni Lee Borg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356096614 PECOS PAC ID: 8820475031 Enrollment ID: I20220509002011 |
| Provider Name | Alison Noel Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437745528 PECOS PAC ID: 0547647497 Enrollment ID: I20220513001765 |
| Provider Name | Colter Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215670013 PECOS PAC ID: 8224419692 Enrollment ID: I20220715001758 |
| Provider Name | Kimberly Jean Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265155204 PECOS PAC ID: 8426420431 Enrollment ID: I20230220001771 |
| Provider Name | Kelsey Despain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700594967 PECOS PAC ID: 5193198059 Enrollment ID: I20230224001007 |
| Provider Name | Nathan Thompson Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558074955 PECOS PAC ID: 8325405723 Enrollment ID: I20230530002573 |
Community Care, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1595 Yellowstone Ave, Pocatello, ID 83201 Phone: 208-233-0032 | |
Family Medical Clinic Of Chubbuck Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 476 E Chubbuck Rd, Pocatello, ID 83202 Phone: 208-233-9898 Fax: 208-232-8566 | |
Superior Physical Therapy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1800 Flandro Dr Ste 190, Pocatello, ID 83202 Phone: 208-233-2248 | |
Health West, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1001 N 7th Ave Ste 135, Pocatello, ID 83201 Phone: 208-232-7862 | |
Health West, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 955 W Alameda Rd, Pocatello, ID 83201 Phone: 208-237-2233 | |
Idaho Sports & Spine Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 950 Hospital Way, Ste A, Pocatello, ID 83201 Phone: 208-478-4522 Fax: 208-478-2935 | |
Mountain View Family Medicine, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2006 Birdie Thompson Dr, Pocatello, ID 83201 Phone: 208-232-1132 Fax: 208-232-1134 |