NPIMap

Organization Active NPI

Upper Valley Family Medicine PLLC

  • Family Medicine Physician
  • Rigby, ID
National Provider Identifier
1073697884
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UPPER VALLEY FAMILY MEDICINE PLLC
Practice address
711 Rigby Lake Dr Ste 115
Rigby, ID 83442-5230
Phone
(208) 745-5021
Fax
(208) 745-5026
NPI assigned
Oct 25, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Darin T Berrett
Title
Office Manager
Phone
(208) 745-5021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

711 Rigby Lake Dr Ste 115
Rigby, ID 83442-5230

Mailing address

711 Rigby Lake Dr Ste 115
Rigby, ID 83442-5230
Phone (208) 745-5021

Other identifiers 2

IdentifierTypeStateIssuer
8067451700MedicaidID
806913600MedicaidID

Other names 1

  • UPPER VALLEY FAMILY MEDICINE Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908000127 ID Part B Supplier - Clinic/Group Practice 9133195548 Receives reassigned benefits from 10 practitioners
Practice locations: Rigby, ID; Terreton, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073697884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 RIGBY LAKE DR STE 115",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425230",
            "telephone_number": "208-745-5021",
            "fax_number": "208-745-5026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 RIGBY LAKE DR STE 115",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425230",
            "telephone_number": "208-745-5021",
            "fax_number": "208-745-5026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER VALLEY FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BERRETT",
        "authorized_official_first_name": "DARIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-745-5021"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8067451700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806913600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPPER VALLEY FAMILY MEDICINE",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rigby, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.