NPIMap

Organization Active NPI

Idaho Kidney Institute LLP

  • Nephrology Physician
  • Chubbuck, ID
National Provider Identifier
1013064690
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
IDAHO KIDNEY INSTITUTE LLP
Practice address
4511 Zebe Ave
Chubbuck, ID 83202-4707
Phone
(208) 904-4780
Fax
(208) 904-4832
NPI assigned
Jan 4, 2007
Last updated
Apr 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Authorized official

Name
Fahim Rahim, M.D.NPI 1164579736
Title
President
Phone
(208) 904-4780

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

4511 Zebe Ave
Chubbuck, ID 83202-4707

Mailing address

PO Box 268934
Oklahoma City, OK 73126-8934
Phone (208) 904-4780

Other identifiers 1

IdentifierTypeStateIssuer
807177400MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050708000247 ID Part B Supplier - Clinic/Group Practice 9032155312 Receives reassigned benefits from 20 practitioners
Practice locations: Gooding, ID; Twin Falls, ID; Rexburg, ID; Idaho Falls, ID; Chubbuck, ID; Burley, ID; Blackfoot, ID

National Provider Directory

National Provider Directory

Locations

1259 Pier View Dr
Idaho Falls, ID 83402

333 Knudsen Blvd
Pocatello, ID 83202
Phone (208) 776-4732

444 Hospital Way
Ste 607
Pocatello, ID 83201
Phone (208) 589-3844

582 Pole Line Rd
Ste E
Twin Falls, ID 83301

Interoperability endpoints

  • Direct secure messaging: amandaprestigiacomo@ikillp.allscriptsdirect.net
  • Direct secure messaging: denisebarnes@ikillp.allscriptsdirect.net
  • Direct secure messaging: hirasiktel@ikillp.allscriptsdirect.net
  • Direct secure messaging: juliettehollingshead@ikillp.allscriptsdirect.net
  • Direct secure messaging: michaelhaderlie@ikillp.allscriptsdirect.net
  • Direct secure messaging: nagrajnarasimhan@ikillp.allscriptsdirect.net
  • Direct secure messaging: nicolebartlett@ikillp.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617840000000",
    "number": "1013064690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268934",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268934",
            "telephone_number": "208-904-4780",
            "fax_number": "208-904-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4511 ZEBE AVE",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832024707",
            "telephone_number": "208-904-4780",
            "fax_number": "208-904-4832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO KIDNEY INSTITUTE LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A",
        "authorized_official_last_name": "RAHIM",
        "authorized_official_first_name": "FAHIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-904-4780",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807177400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chubbuck, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; 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.