NPIMap

Organization Active NPI

Psychiatric Associates Services PLLC

  • Physician Assistant
  • Nampa, ID
National Provider Identifier
1053074302
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
PSYCHIATRIC ASSOCIATES SERVICES PLLC
Practice address
1019 W Sanetta St
Nampa, ID 83651-5047
Phone
(208) 917-1842
Fax
(208) 549-7017
NPI assigned
Oct 14, 2021
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
William Short, PANPI 1780928580
Title
Member
Phone
(082) 912-4416

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
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

1019 W Sanetta St
Nampa, ID 83651-5047

Mailing address

1775 W State St # 383
Boise, ID 83702-3924
Phone (208) 912-4416

Other practice location 1

4615 W Emerald St
Boise, ID 83706-2002
Phone (208) 917-1842

Other practice location 2

1044 Northwest Blvd
Coeur D Alene, ID 83814-2114
Phone (208) 917-1842

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220114000386 ID Part B Supplier - Clinic/Group Practice 7315339785 Receives reassigned benefits from 5 practitioners
Practice locations: Boise, ID; Coeur D Alene, ID; Nampa, ID

National Provider Directory

National Provider Directory

Locations

4615 W Emerald St
Boise, ID 83706
Phone (208) 344-2228

1044 Northwest Blvd
Coeur D Alene, ID 83814
Phone (208) 917-1842

1019 W Sanetta St
Nampa, ID 83651
Phone (208) 462-3392

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1053074302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 W STATE ST # 383",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837023924",
            "telephone_number": "208-912-4416",
            "fax_number": "208-549-5832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 W SANETTA ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836515047",
            "telephone_number": "208-917-1842",
            "fax_number": "208-549-7017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4615 W Emerald St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837062002",
            "country_code": "US",
            "telephone_number": "208-917-1842",
            "fax_number": "208-549-7017",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1044 Northwest Blvd",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142114",
            "country_code": "US",
            "telephone_number": "208-917-1842",
            "fax_number": "208-549-7017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHIATRIC ASSOCIATES SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "082-912-4416",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; 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.