Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1043339641 Individual Practitioner Male Practitioner

Dr. Kenneth Todd Blackner , MD

General Practice • Shelley, ID

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Blackner, MD is a registered healthcare professional specializing in General Practice in Shelley, ID. Practice services are available at 275 W LOCUST ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

275 W Locust St

Shelley, ID 832741230

Telephone 2083573960
Associated Practice Facility / Clinic
🏢 Bingham Memorial Hospital Facility NPI 1508989765

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Shelley, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 23.6 Yrs
Regional Practice Density
1 Specialists

Practicing in Shelley, ID (37 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License ID M-11785

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

General Practice

NUCC Taxonomy Code: 208D00000X

State License VA 0101240258

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active February 03, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location February 03, 2016

Registered at 275 W LOCUST ST, SHELLEY, ID 832741230 (Tel: 2083573960)

📍
Updated Business Mailing Address February 03, 2016

Registered at 618 E 1450 N, SHELLEY, ID 832745078 (Tel: 7576173339)

👤
Provider Name / Credentials Updated February 03, 2016

Recorded as KENNETH BLACKNER, M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 03, 2016

General Practice (License #M-11785 in ID)

🟢
Initial NPI Registration & Enumeration March 28, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1043339641
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 28, 2007
Last Update: February 03, 2016
Sole Proprietor: Yes

Mailing Address

618 E 1450 N

Shelley, ID 832745078

Phone: 7576173339

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.