NPIMap

Individual provider Active NPI

Kimberly Dolecheck Tverdy, PA-C

  • Physician Assistant
  • Twin Falls, ID
National Provider Identifier
1073022778
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1524 Issued in ID
Practice address
775 Pole Line Rd W Ste 203
Twin Falls, ID 83301-5820
Phone
(208) 814-8300
NPI assigned
Sep 25, 2017
Last updated
Aug 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1524 ID Primary

Addresses

Primary practice location

775 Pole Line Rd W Ste 203
Twin Falls, ID 83301-5820

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-8752

Other practice location 1

1151 Hospital Way Bldg A
Pocatello, ID 83201-5091
Phone (208) 232-6616

Other names 1

  • Kimberly Jeanne Dolecheck Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180110003330 ID Practitioner - Physician Assistant 6507125937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

746 N College Rd
Twin Falls, ID 83301-3486

775 Pole Line Rd W
Twin Falls, ID 83301-5820

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC CurrentSince Oct 25, 2017 Accepting new patients
Pocatello Hospital LLC Current Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

1151 Hospital Way
Bldg A
Pocatello, ID 83201
Phone (208) 232-6616

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1073022778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-8752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 203",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015820",
            "telephone_number": "208-814-8300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1151 Hospital Way Bldg A",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832015091",
            "country_code": "US",
            "telephone_number": "208-232-6616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TVERDY",
        "first_name": "KIMBERLY",
        "middle_name": "DOLECHECK",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "DOLECHECK",
            "middle_name": "JEANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.