Active NPI
CSRM LLC
Doing business as Kestrel Therapy Group
- Hand Occupational Therapist
- Boise, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Occupational Therapist
- Legal business name
- CSRM LLC
- Doing business as
- Kestrel Therapy Group
- Practice address
- 7979 W Rifleman St Ste 200
Boise, ID 83704-9066 - Phone
- (208) 377-3850
- NPI assigned
- Sep 19, 2022
- Last updated
- Sep 19, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ronald Dale Miller Jr.
- Title
- Owner
- Phone
- (208) 377-3850
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | NU | Primary |
Addresses
Primary practice location
7979 W Rifleman St Ste 200
Boise, ID 83704-9066
Mailing address
7979 W Rifleman St Ste 200
Boise, ID 83704-9066
Phone (208) 377-3850
Other names 1
- Kestrel Therapy Group
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230126001674 | ID | DME Supplier - Independently-Practicing Occupational Therapist | 4789078312 | Practice locations: Boise, ID |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Kestrel Therapy Group
- Hand Occupational Therapist
- Meridian, ID
- NPI 1588301386
4789078312
National Provider Directory
National Provider Directory- Tax ID family
- CSRM LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
Locations
7979 W Rifleman St
Ste 200
Boise, ID 83704
Phone (208) 377-3850
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Physical Therapist
- Boise, ID
- NPI 1952352601
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663545600000",
"number": "1083337711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7979 W RIFLEMAN ST STE 200",
"city": "BOISE",
"state": "ID",
"postal_code": "837049066",
"telephone_number": "208-377-3850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7979 W RIFLEMAN ST STE 200",
"city": "BOISE",
"state": "ID",
"postal_code": "837049066",
"telephone_number": "208-377-3850"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CSRM LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-19",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "RONALD",
"authorized_official_middle_name": "DALE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-377-3850",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Kestrel Therapy Group",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.