NPIMap

Organization Active NPI

Salmon River Clinic Hospital District

Doing business as Salmon River Clinic

  • Family Medicine Physician
  • Stanley, ID
National Provider Identifier
1083796569
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-4162 Issued in ID
Legal business name
SALMON RIVER CLINIC HOSPITAL DISTRICT
Doing business as
Salmon River Clinic
Practice address
110 Niece Avenue
Stanley, ID 83278-0129
Phone
(208) 774-3565
NPI assigned
Oct 20, 2006
Last updated
Mar 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Authorized official

Name
Amy Mercantini Klingler, PA-CNPI 1568429082
Title
PA/Administrator
Phone
(208) 774-3565

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-492 ID
Family Medicine Physician 207Q00000X M-4162 ID Primary

Addresses

Primary practice location

110 Niece Avenue
Stanley, ID 83278-0129

Mailing address

PO Box 129
Stanley, ID 83278-0129
Phone (208) 774-3565

Other identifiers 1

IdentifierTypeStateIssuer
806387200MedicaidID

Other names 1

  • Salmon River Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030425000035 ID Part A Provider - Rural Health Clinic 6204745078 Practice locations: Stanley, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083796569. Details of each certification follow.

Rural health clinic certification: CCN 133808

Legal name
SALMON RIVER CLINIC HOSPITAL DISTRICT
Doing business as
SALMON RIVER CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 11, 1980
Last certification
Oct 12, 2006
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1 Niece Avenue
Stanley, ID 83278

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Salmon River Emerg Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Amy M Klingler Individual W-2 Managing Employee Nov 12, 2012
David Kimpton Individual Corporate Officer Nov 12, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773964800000",
    "number": "1083796569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "STANLEY",
            "state": "ID",
            "postal_code": "832780129",
            "telephone_number": "208-774-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 NIECE AVENUE",
            "city": "STANLEY",
            "state": "ID",
            "postal_code": "832780129",
            "telephone_number": "208-774-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALMON RIVER CLINIC HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A",
        "authorized_official_last_name": "KLINGLER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "MERCANTINI",
        "authorized_official_title_or_position": "PA/ADMINISTRATOR",
        "authorized_official_telephone_number": "208-774-3565",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-492",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-4162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806387200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salmon River Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stanley, ID

Sources for this page

Verify at the official NPI Registry.