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MR. BO ROBERT SMITH
NPI 1104623784
Counselor - Mental Health in Blackfoot, ID

Active since February 28, 2025PECOS Enrolled
1309 CAMAS ST, BLACKFOOT, ID 83221(208) 782-0675 Get Directions Write a Review

NPPES record last updated: February 28, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Bo Robert Smith NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. BO ROBERT SMITH (NPI 1104623784) is an individual mental health provider in Blackfoot, Idaho, licensed in Idaho (3071150) and active in the NPI registry since February 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1104623784
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameMR. BO ROBERT SMITH
Location Address1309 CAMAS STBlackfoot, ID 83221-3060
Mailing Address297 Pendlebury Ln Apt 1Blackfoot, ID 83221-2815
Phone(208) 782-0675
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateFebruary 28, 2025
NPPES CertifiedFebruary 28, 2025
✔ NPI 1104623784 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in ID · 3071150
1309 CAMAS ST, Blackfoot, ID 83221
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Bo Robert Smith is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7214437474
PECOS Enrollment IDI20250821004819
Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MADISON J RHODES LMSW
Social Worker
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675
NICOLE CRIDDLE LMSW
Social Worker
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675
STILL WATERS COUNSELING LLC
Case Management
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675
STILLWATERS COUNSELING LLC
Counselor (Mental Health)
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675
STILL WATERS COUNSELING LLC
Social Worker
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0678
BEN LAZARUS FOX LMSW
Social Worker (Clinical)
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675
ZANE CHRISTIAN STEPHENSON
Counselor (Professional)
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675
STILLWATERS COUNSELING LLC
Peer Specialist
1309 CAMAS ST
BLACKFOOT, ID 83221
Bingham County (208) 782-0675

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bo Smith's NPI number?

The NPI number for Bo Smith is 1104623784. It was assigned to this individual provider in the NPPES registry on February 28, 2025.

Where is Bo Smith located?

Bo Smith practices at 1309 Camas St, Blackfoot, ID 83221. The listed phone number is (208) 782-0675.

What is Bo Smith's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Bo Smith enrolled in Medicare?

Yes. Bo Smith is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Bo Smith was last updated on February 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.