Riverside Primary Care Adult and Geriatric Medicine Plllp

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

RIVERSIDE PRIMARY CARE ADULT AND GERIATRIC MEDICINE PLLLP

Practice address

1673 W Shoreline Dr Ste 100
Boise, ID 83702-6749

Phone

(208) 593-3054

NPI assigned

Sep 13, 2023

Last updated

Sep 13, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Long, NPNPI 1194244707

Title

Co-Owner

Phone

(208) 850-1940

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Beth Long, AGNP-C

  • Nurse Practitioner
  • Eagle, ID
  • NPI 1194244707
  Medicare reassignment Care Compare group NPD Authorized official
• Carla D Dirmann, NP

  • Family Nurse Practitioner
  • Boise, ID
  • NPI 1851624282
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1003693961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 W SHORELINE DR STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 W SHORELINE DR STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026749",
            "telephone_number": "208-593-3054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PRIMARY CARE ADULT AND GERIATRIC MEDICINE PLLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "208-850-1940",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Fernando A Riveron, MD
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• Riverside Rehab, Inc
• Riverside Rehab, Inc.
• Riversong Speech and Language

• Geriatric Medicine (Family Medicine) Physician in Boise, ID
• Providers in Boise, ID by specialty
• Geriatric Medicine (Family Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.