Associates in Family Practice Inc
Organization Active NPI Family Medicine Physician · Gooding, ID
NPI 1023030848 · NPPES record last updated Jan 17, 2025
Key facts
- NPI
- 1023030848
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ASSOCIATES IN FAMILY PRACTICE INC
- Practice address
- 425 Idaho St
Gooding, ID 83330 - Phone
- (208) 934-5900
- Fax
- (208) 934-5719
- NPI assigned
- Jul 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Susie Thompson
- Title
- Office Manager
- Phone
- (208) 934-5900
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 7
-
Travis Chandler, NP-C
-
Stephen M Williams, PAC
-
Jason Davis, PA
-
Mark D Spencer, MD
-
Steven L Berry, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Rural health clinic certification: CCN 133850
- Legal name
- ASSOCIATES IN FAMILY PRACTICE INC
- Doing business as
- ASSOCIATES IN FAMILY PRACTICE, PA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 13, 2003
- Last certification
- Oct 13, 2003
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jul 28, 1997 in ID
- Enrollment address
- 410 N. Idaho Street
Wendell, ID 83355-5038
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Florian J Gies |
5% Or Greater Direct Ownership Interest | Jul 27, 1997 | |
| Corporate Director | Jul 24, 2003 | ||
| Karen Rosa |
W-2 Managing Employee | Mar 18, 2011 | |
| Dana Gies |
W-2 Managing Employee | Jun 2, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030724000006 | ID | Part a Provider - Rural Health Clinic | 2163330325 | Practice locations: Wendell, ID |
| O20031107000393 | ID | Part B Supplier - Clinic/Group Practice | 2163330325 |
Receives reassigned benefits from 13 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wendell, ID; Hagerman, ID; Gooding, ID |
National Provider Directory
Locations
640 Frogs Lndg
Hagerman, ID 83332
Phone (208) 731-6241
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
425 Idaho St
Gooding, ID 83330
Mailing address
PO Box 500
Wendell, ID 83355
Phone (208) 536-5900
Other providers in Gooding, ID
- Glen R Albertson Jr.
- Joshua Dan Allen
- Michael Anthoney
- Apex Adventure Therapy
- Celina Arroyo
- Associates in Family Practice Inc
- Associates in Family Practice Inc
- Associates in Family Practice Inc
- Brandi Ann Bartholomew
- BBPT Inc
All providers in Gooding, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.