NPIMap

Organization Active NPI

Core Medicine Idaho, LLC

Doing business as Core Medicine of Idaho

  • Primary Care Clinic/Center
  • Caldwell, ID
National Provider Identifier
1043927882
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CORE MEDICINE IDAHO, LLC
Doing business as
Core Medicine of Idaho
Practice address
4605 Enterprise Way
Ste 101
Caldwell, ID 83605-8360
Phone
(208) 353-7518
NPI assigned
Nov 1, 2022
Last updated
Jan 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Authorized official

Name
Sophie Rath
Title
Mananger
Phone
(208) 795-5090

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Urgent Care Clinic/Center 261QU0200X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

4605 Enterprise Way
Ste 101
Caldwell, ID 83605-8360

Mailing address

2667 E Gala CT Ste 130
Meridian, ID 83642-2788
Phone (208) 795-5090

Other identifiers 1

IdentifierTypeStateIssuer
1295734796MedicaidID

Other names 1

  • Core Medicine of Idaho Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240205003476 ID Part B Supplier - Clinic/Group Practice 8921441163 Receives reassigned benefits from 7 practitioners
Practice locations: Caldwell, ID

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
13D2287103Core Medicine of Idaho LLC4605 Enterprise Way Ste 101, Caldwell, ID 83605Provider-performed microscopyAug 8, 2027

National Provider Directory

National Provider Directory

Locations

4605 Enterprise Way
Ste 101
Caldwell, ID 83605
Phone (208) 353-7518

2667 E Gala Ct
Ste 130
Meridian, ID 83642
Phone (208) 459-0891

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1043927882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2667 E GALA CT STE 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422788",
            "telephone_number": "208-795-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 ENTERPRISE WAY",
            "address_2": "STE 101",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836058360",
            "telephone_number": "208-353-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE MEDICINE IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-01",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A",
        "authorized_official_last_name": "RATH",
        "authorized_official_first_name": "SOPHIE",
        "authorized_official_title_or_position": "MANANGER",
        "authorized_official_telephone_number": "208-795-5090"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295734796",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Core Medicine of Idaho",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Core Medicine of Idaho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.