NPIMap

Organization Active NPI

Ashton Memorial, Inc.

Doing business as Youth and Family Renewal Services

  • Mental Health Counselor
  • Idaho Falls, ID
National Provider Identifier
1003907163
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ASHTON MEMORIAL, INC.
Doing business as
Youth and Family Renewal Services
Practice address
2935 Rollandet St
Idaho Falls, ID 83402-4654
Phone
(208) 542-2905
Fax
(208) 522-2427
NPI assigned
Sep 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sheila Kellogg
Title
Administrator
Phone
(208) 652-7461

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

2935 Rollandet St
Idaho Falls, ID 83402-4654

Mailing address

PO Box 838
700 N. 2ND Street
Ashton, ID 83420-0838
Phone (208) 652-7461

Other identifiers 4

IdentifierTypeStateIssuer
807361800MedicaidID
805100400MedicaidID
807195500MedicaidID
807641700MedicaidID

Other names 1

  • Youth and Family Renewal Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080529000529 ID Part B Supplier - Clinic/Group Practice 7719898873 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Ashton, ID; Island Park, ID

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003907163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 838",
            "address_2": "700 N. 2ND STREET",
            "city": "ASHTON",
            "state": "ID",
            "postal_code": "834200838",
            "telephone_number": "208-652-7461",
            "fax_number": "208-652-7595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 ROLLANDET ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834024654",
            "telephone_number": "208-542-2905",
            "fax_number": "208-522-2427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHTON MEMORIAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-652-7461"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807361800",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805100400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807195500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807641700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Youth and Family Renewal Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.