| 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 | () | Primary |
| Provider Name | Kristi L Grigg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831118801 PECOS PAC ID: 0345212676 Enrollment ID: I20040809000300 |
| Provider Name | James L Blaine |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801963459 PECOS PAC ID: 1254303498 Enrollment ID: I20040809001269 |
| Provider Name | Gordon E Dixon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578518395 PECOS PAC ID: 3274442116 Enrollment ID: I20040929000890 |
| Provider Name | Derek B Eddie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346375367 PECOS PAC ID: 6709978265 Enrollment ID: I20070828001107 |
| Provider Name | Joshua E Hansen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588948087 PECOS PAC ID: 7012181530 Enrollment ID: I20111118000565 |
| Provider Name | Trevor R Bartlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639442973 PECOS PAC ID: 1456515840 Enrollment ID: I20120615000028 |
| Provider Name | Cristy Waters |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760753081 PECOS PAC ID: 0042472227 Enrollment ID: I20140820001413 |
| Provider Name | Scott Bradley Schaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720410012 PECOS PAC ID: 2961620620 Enrollment ID: I20140821002846 |
| Provider Name | Duane B Mortenson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578848487 PECOS PAC ID: 1850568189 Enrollment ID: I20141008002028 |
| Provider Name | Jamie L Gudmunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669853719 PECOS PAC ID: 3971816448 Enrollment ID: I20150714000351 |
| Provider Name | Justin S Nielsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235443193 PECOS PAC ID: 1456543883 Enrollment ID: I20150730012740 |
| Provider Name | Justus F Lambson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922262542 PECOS PAC ID: 9133439573 Enrollment ID: I20151113002211 |
| Provider Name | Amber Rae Hays |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922458538 PECOS PAC ID: 9335434265 Enrollment ID: I20160817000755 |
| Provider Name | Janna K Baker |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376842138 PECOS PAC ID: 5395923924 Enrollment ID: I20160908000859 |
| 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 | Matthew F Ivie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003325937 PECOS PAC ID: 6608134218 Enrollment ID: I20180102002270 |
| 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 | Todd I Cranor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1477021020 PECOS PAC ID: 6800136110 Enrollment ID: I20190325001324 |
| Provider Name | Hailey a Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487125969 PECOS PAC ID: 8921348129 Enrollment ID: I20190326002408 |
| Provider Name | Tawny a Spurlock |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255808010 PECOS PAC ID: 8921349903 Enrollment ID: I20190402000708 |
| Provider Name | Magno C Santos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881935104 PECOS PAC ID: 0143454173 Enrollment ID: I20190604001208 |
| Provider Name | Tina Scoggins |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1689037129 PECOS PAC ID: 3375882988 Enrollment ID: I20191030002281 |
| Provider Name | Benjamin J Atwood |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821645870 PECOS PAC ID: 7911339023 Enrollment ID: I20191111002802 |
| Provider Name | Rebekah M Lucero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285295634 PECOS PAC ID: 3779915582 Enrollment ID: I20191118000040 |
| Provider Name | Hilary Zitlau |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740816511 PECOS PAC ID: 8123449907 Enrollment ID: I20200603000994 |
| 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 | Tate Coltan Staker |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184253585 PECOS PAC ID: 1456767508 Enrollment ID: I20210315002575 |
| Provider Name | Shad Crapo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912476649 PECOS PAC ID: 2163764960 Enrollment ID: I20210323000727 |
| Provider Name | Jordan Forbush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821680166 PECOS PAC ID: 5496154684 Enrollment ID: I20210519003174 |
| Provider Name | Sam Jensen Wright |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457023244 PECOS PAC ID: 4486042405 Enrollment ID: I20211025002019 |
| Provider Name | Tim R 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 | Ariel Taysom |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609341098 PECOS PAC ID: 2769726447 Enrollment ID: I20220801002930 |
| Provider Name | Jaden Juergens |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538810577 PECOS PAC ID: 9133597644 Enrollment ID: I20221114003184 |
| Provider Name | Wesley Kenyon Butler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881317329 PECOS PAC ID: 6709257926 Enrollment ID: I20230126002368 |
| 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 | Travis Gilbert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770093619 PECOS PAC ID: 1153682232 Enrollment ID: I20230428002062 |
| Provider Name | Nathan Thompson Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558074955 PECOS PAC ID: 8325405723 Enrollment ID: I20230530002573 |
| Provider Name | Leathie Bickmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609640333 PECOS PAC ID: 9032554175 Enrollment ID: I20240228004836 |
| Provider Name | Christopher Leif Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023886397 PECOS PAC ID: 9032555057 Enrollment ID: I20240313001878 |
| Provider Name | Melisa Stacey Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043074537 PECOS PAC ID: 8325585607 Enrollment ID: I20240805001214 |
| Provider Name | Jenny M Ball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306674197 PECOS PAC ID: 3577090653 Enrollment ID: I20241231003222 |
| Provider Name | Heather Lin Halversen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801526199 PECOS PAC ID: 7517460314 Enrollment ID: I20250909003534 |
| Provider Name | Joshua Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194693689 PECOS PAC ID: 6103399985 Enrollment ID: I20260623004226 |
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 City Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1001 N 7th Ave Ste 135, Pocatello, ID 83201 Phone: 208-232-7862 |
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 |