MRS. BEVERLEY ANN BLAKE ODOHERTY (CFNP) – Family Nurse Practitioner, NPI 1821166539
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,798 NURSE PRACTITIONER in ID
Provider Addresses for MRS. BEVERLEY ANN BLAKE ODOHERTY (CFNP)
190 E BANNOCK ST
BOISE, ID 837126241
Phone: (208) 381-8752
Type: Mailing
777 Hospital Way
Pocatello, ID 832015175
Phone: (208) 239-1000
Type: Location
801 POLE LINE RD W
TWIN FALLS, ID 833015810
Phone: (208) 814-4100
Fax: (208) 814-4908
Type: Location
Portneuf Medical Center, 777, Hospital Way, Pocatello, Bannock County, Idaho, 83201, United States
POCATELLO, ID 832015175
Phone: (208) 239-1000
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-03-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 5 Medicare enrollment records; no due dates published yet.
Enrollment records
5
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050222000969 | I | Nurse Practitioner | MT | TBD |
| I20091229000076 | I | Nurse Practitioner | ID | TBD |
| I20180702000814 | I | Nurse Practitioner | TX | TBD |
| I20191202001316 | I | Nurse Practitioner | OR | TBD |
| I20260304003913 | I | Nurse Practitioner | PA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 139 | 137 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 26 | 26 | $0 |
| 99497 | Advance care planning, first 30 minutes | 13 | 13 | $0 |
Insurance plans in this area (ZIP 83712)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | PA | |
| Certified Registered Nurse Anesthetist (Crna) | PA | |
| Diagnostic Radiology | NY | |
| Certified Registered Nurse Anesthetist (Crna) | PA | |
| N E U R O L O G Y | PA | |
| Critical Care (Intensivists), Internal Medicine, Pulmonary Disease, Hospitalist | NC | |
| Nurse Practitioner | PA | |
| Diagnostic Radiology | OH | |
| Diagnostic Radiology | PA | |
| Nurse Practitioner | PA |
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