NPIMap

Organization Active NPI

ASC Northwest LLC

  • Ambulatory Surgical Clinic/Center
  • Coeur D Alene, ID
National Provider Identifier
1033712781
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ASC NORTHWEST LLC
Practice address
850 W Ironwood Dr Ste B-101
Coeur D Alene, ID 83814-4903
Phone
(208) 667-1376
NPI assigned
Nov 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Authorized official

Name
Kellie Carter
Title
Practice Manager
Phone
(208) 667-1376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

850 W Ironwood Dr Ste B-101
Coeur D Alene, ID 83814-4903

Mailing address

850 W Ironwood Dr Ste B-101
Coeur D Alene, ID 83814-4903
Phone (208) 667-1376

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130325000551 ID Part B Supplier - Clinic/Group Practice 0648415547 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coeur D Alene, ID; Post Falls, ID
O20220907000513 ID Part B Supplier - Ambulatory Surgical Center 0446634661 Practice locations: Coeur D Alene, ID

Ambulatory surgical center certification: CCN 13C0001103

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ASC NORTHWEST LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Sep 7, 2022
Last certification
Sep 7, 2022
Ownership / control type
Proprietary
Facility address
850 W Ironwood Dr
Coeur d'Alene, ID 83814

Other NPIs on the same Medicare enrollment 1

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

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
13D2234793ASC Northwest850 W Ironwood Dr Ste 300, Coeur D'Alene, ID 83814Certificate of waiverSep 1, 2027

National Provider Directory

National Provider Directory

Locations

850 W Ironwood Dr
Ste 300
Coeur D Alene, ID 83814
Phone (208) 457-7078

850 W Ironwood Dr
#B101
Coeur D Alene, ID 83814

850 W Ironwood Dr
Ste B101
Coeur D Alene, ID 83814
Phone (208) 292-4553

1002 N Spokane St
Post Falls, ID 83854
Phone (208) 277-4964

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1033712781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W IRONWOOD DR STE B-101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144903",
            "telephone_number": "208-667-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W IRONWOOD DR STE B-101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144903",
            "telephone_number": "208-667-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASC NORTHWEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-667-1376"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.