NPIMap

Organization Active NPI

Teton Valley Health Care Inc

Doing business as Driggs Clinic

  • Rural Health Clinic/Center
  • Driggs, ID
National Provider Identifier
1013264183
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
31 Issued in ID
Legal business name
TETON VALLEY HEALTH CARE INC
Doing business as
Driggs Clinic
Practice address
283 N 1St E
Driggs, ID 83422-5109
Phone
(208) 354-2302
Fax
(208) 354-8392
NPI assigned
Aug 8, 2012
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Jill Payne
Title
Chief of Compliance
Phone
(208) 354-6352

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 31 ID Primary
Medical Physician Assistant 363AM0700X ID
Family Nurse Practitioner 363LF0000X ID
Pediatric Nurse Practitioner 363LP0200X ID
Pain Medicine (Anesthesiology) Physician 207LP2900X
Family Medicine Physician 207Q00000X ID
Ophthalmology Physician 207W00000X ID
Orthopaedic Surgery Physician 207X00000X ID
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X ID
Otolaryngology Physician 207Y00000X ID
Surgery Physician 208600000X ID
Interventional Pain Medicine Physician 208VP0014X ID

Addresses

Primary practice location

283 N 1St E
Driggs, ID 83422-5109

Mailing address

120 E Howard St
Driggs, ID 83422-5112
Phone (208) 354-6302

Other names 1

  • Driggs Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121120000517 ID Part A Provider - Rural Health Clinic 3870744956 Practice locations: Driggs, ID
O20121128000587 ID Part B Supplier - Clinic/Group Practice 3870744956 Receives reassigned benefits from 94 practitioners
2 other NPIs on this enrollment
Practice locations: Driggs, ID; Victor, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013264183. Details of each certification follow.

Rural health clinic certification: CCN 138511

Legal name
TETON VALLEY HEALTH CARE INC
Doing business as
DRIGGS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2007
Last certification
Feb 13, 2003
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jan 11, 2012 in ID
Enrollment address
283 N 1St E
Driggs, ID 83422-5109
Related CCNs
131313

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

285 E Little Ave
Driggs, ID 83422
Phone (208) 354-1999

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lori Leianne Everett Individual Corporate OfficerCfo, Interim Ceo Dec 15, 2023
W-2 Managing EmployeeAd; Sep 25, 2025
Ken Dunn Individual Corporate Director Feb 16, 2024
Gene Marcowka Individual Corporate Director Feb 16, 2024
Anjali S Tate Individual Corporate Director Feb 16, 2024
Nathan Levanger Individual W-2 Managing EmployeeMD; Apr 1, 2025
Jill Payne Individual W-2 Managing EmployeeDirector of Compliance Mar 5, 2024
Jo Anne Kay Individual Corporate Director Feb 16, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1013264183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E HOWARD ST",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225112",
            "telephone_number": "208-354-6302",
            "fax_number": "208-354-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 N 1ST E",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225109",
            "telephone_number": "208-354-2302",
            "fax_number": "208-354-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON VALLEY HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "CHIEF OF COMPLIANCE",
        "authorized_official_telephone_number": "208-354-6352"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ID",
            "license": "31",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "ID",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Driggs Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Driggs Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Driggs, ID

Sources for this page

Verify at the official NPI Registry.