NPIMap

Organization Active NPI

Ridley's Family Markets, Inc

Doing business as Ridley's Pharmacy #8464

  • Community/Retail Pharmacy
  • Kimberly, ID
National Provider Identifier
1003942913
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1730CP Issued in ID
Legal business name
RIDLEY'S FAMILY MARKETS, INC
Doing business as
Ridley's Pharmacy #8464
Practice address
210 Main St. South
Kimberly, ID 83341-0443
Phone
(208) 423-4248
Fax
(208) 423-5767
NPI assigned
Feb 26, 2007
Last updated
May 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

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

Authorized official

Name
Dr. Cathi Ketterling, PHARMD
Title
President
Phone
(208) 324-4633

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1730 CP ID
Community/Retail Pharmacy 3336C0003X 1730CP ID Primary

Addresses

Primary practice location

210 Main St. South
Kimberly, ID 83341-0443

Mailing address

621 Washington St. South
Twin Falls, ID 83301-5519
Phone (208) 324-4633

Other identifiers 1

IdentifierTypeStateIssuer
806621200MedicaidID

Other names 1

  • Ridley's Pharmacy #8464 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160817003238 ID Part B Supplier - Mass Immunization (Roster Biller Only) 6709170111 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wendell, ID; Blackfoot, ID; Weiser, ID; Star, ID; Rupert, ID; Pocatello, ID; Kuna, ID; Kimberly, ID…

Other NPIs on the same Medicare enrollment 13

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

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2019659Ridley's Pharmacy #8464210 Main St S, Kimberly, ID 83341Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ridleys Family Markets Inc36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

210 Main St S
Kimberly, ID 83341
Phone (208) 423-4248

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1003942913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 WASHINGTON ST. SOUTH",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015519",
            "telephone_number": "208-324-4633",
            "fax_number": "208-324-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MAIN ST. SOUTH",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "833410443",
            "telephone_number": "208-423-4248",
            "fax_number": "208-423-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDLEY'S FAMILY MARKETS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "KETTERLING",
        "authorized_official_first_name": "CATHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-324-4633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "1730 CP",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "1730CP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806621200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridley's Pharmacy #8464",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kimberly, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; 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.