Russell R. Blakeley (NPI# 1063409639, PAC ID# 0345212585) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CARDIOVASCULAR DISEASE (CARDIOLOGY).
| Nation Provider ID (NPI) | 1063409639 |
| PAC ID by PECOS | 0345212585 |
| Professional Enrollment ID | I20141121001990 |
| Full Name | Russell R. Blakeley |
| Organization Legal Name | BOUNDARY COMMUNITY HOSPITAL |
| Address |
6640 Kaniksu St Bonners Ferry ID 83805-7532 |
| Phone Number | 2082673141 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO |
| Graduation Year | 1982 |
| Primary Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| Group Practice PAC ID | 3274583406 |
| Number of Group Practice Members | 10 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 131328 | BONNER GENERAL HOSPITAL |
| 131301 | BOUNDARY COMMUNITY HOSPITAL |
| 130049 | KOOTENAI HEALTH |
| 501310 | NEWPORT COMMUNITY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2082673141 | BOUNDARY COMMUNITY HOSPITAL |
| 700 W Ironwood Dr, Suite 320, Coeur D Alene, ID 83814-4485 | 2086255250 | KOOTENAI HEALTH |
| 423 N 3rd Ave, Suite 355, Sandpoint, ID 83864-1511 | 2082632505 | KOOTENAI HEALTH |
| 122 W 7th Ave, Suite 310, Spokane, WA 99204-2352 | 5098387711 | KOOTENAI HEALTH |
| Organization Legal Name | BOUNDARY COMMUNITY HOSPITAL |
| Physicians | 9 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Chuck L Newhouse | Family Practice | Boundary Community Hospital | 6641 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Casey J Fatz | Diagnostic Radiology | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Michael J Yourzek Sr. | Physician Assistant | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Gregory T Botkin | Family Medicine | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Philip John Dougherty | Diagnostic Radiology | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Susan J Layeux | Family Medicine | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Beverly Jane Yercheck | Nurse Practitioner | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Janet M Lukehart | Nurse Practitioner | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Street Address |
6640 KANIKSU ST |
| City | BONNERS FERRY |
| State | ID |
| Zip | 83805-7532 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Casey J Fatz | Diagnostic Radiology | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Michael J Yourzek Sr. | Physician Assistant | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Gregory T Botkin | Family Medicine | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Nathan C Kanning | General Surgery | Sandpoint Surgical Associates | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Philip John Dougherty | Diagnostic Radiology | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Susan J Layeux | Family Medicine | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Beverly Jane Yercheck | Nurse Practitioner | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Chase C Williams | General Surgery | Sandpoint Surgical Associates | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Janet M Lukehart | Nurse Practitioner | Boundary Community Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joshua O Shelton | Chiropractic | 510686 Hwy 95, Bonners Ferry, ID 83805-5301 | |
| Paul Stuart Hyer | Chiropractic | 510686 Hwy 95, Bonners Ferry, ID 83805-5301 | |
| Tracey A Koch | Nurse Practitioner | Kootenai Tribe of Idaho | 100 Circle Dr, Bonners Ferry, ID 83805-5483 |
| Mary R Fiedler | Nurse Practitioner | Public Health District 1 | 7402 Caribou St, Bonners Ferry, ID 83805-7512 |
| Amanda D Horricks | Physician Assistant | Bonners Ferry Family Medicine Pllc | 6488 Chinook St, Bonners Ferry, ID 83805-7515 |
| Sherry Lee Bushnell | Nurse Practitioner | Bonners Ferry Family Medicine Pllc | 6488 Chinook St, Bonners Ferry, ID 83805-7515 |
| Troy W Geyman | Family Medicine | Bonners Ferry Family Medicine Pllc | 6488 Chinook St, Bonners Ferry, ID 83805-7515 |
| Kelli L Wright | Clinical Social Worker | Bonners Ferry Family Medicine Pllc | 6488 Chinook St, Bonners Ferry, ID 83805-7515 |
| Ryan James Gorman | Nurse Practitioner | Bonners Ferry Family Medicine Pllc | 6488 Chinook St, Bonners Ferry, ID 83805-7515 |
| Haley Marie Halleman | Physician Assistant | Bonners Ferry Family Medicine Pllc | 6488 Chinook St, Bonners Ferry, ID 83805-7515 |
| Find all physicians in zip 83805 | |||
| City | BONNERS FERRY |
| Zip Code | 83805 |
| Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| City + Specialty | BONNERS FERRY + CARDIOVASCULAR DISEASE (CARDIOLOGY) |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.