NPIMap

Alliance Medical Group, LLC

Organization Active NPI Family Medicine Physician · Caldwell, ID

NPI 1073079463 · NPPES record last updated Feb 17, 2025

Key facts

NPI
1073079463
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
ALLIANCE MEDICAL GROUP, LLC
Practice address
512 N 21St Ave
Caldwell, ID 83605-4368
Phone
(208) 809-2875
Fax
(208) 809-2876
NPI assigned
Feb 11, 2019
Organization subpart
No

Authorized official

Name
Linda Barnes
Title
Credentialing MGR
Phone
(208) 985-1423

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 134

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

View all 134

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2163514Primary Health Medical Group-North Caldwell
512 N 21St Ave, Caldwell, ID 83605		Provider-performed microscopyMar 14, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ID

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190509002527 ID DME Supplier - Physician - Family Practice 3971544685 Practice locations: Caldwell, ID

National Provider Directory

Tax ID family
Alliance Medical Group LLC (17 organizations share this tax ID)

Locations

512 N 21st Ave
Caldwell, ID 83605
Phone (208) 809-2875

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

512 N 21St Ave
Caldwell, ID 83605-4368

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6522

Other names

  • Primary Health Medical Group Doing business as

Other providers in Caldwell, ID

All providers in Caldwell, ID · Family Medicine Physician in Idaho

Sources for this page

Verify at the official NPI Registry.