Individual provider Active NPI

Christine Danielle Hansen, PA

  • Physician Assistant
  • Nampa, ID
National Provider Identifier
1104558568
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-2601 Issued in ID
Practice address
11035 Karcher Rd
Nampa, ID 83651-8200
Phone
(208) 302-6650
Fax
(208) 302-6655
NPI assigned
Jun 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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-2601 ID Primary

Addresses

Primary practice location

11035 Karcher Rd
Nampa, ID 83651-8200

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 302-9342

Other practice location 1

921 S 8th Ave Stop 8253
Pocatello, ID 83209-0002
Phone (208) 282-4726

Other names 1

  • Christine Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231128002840 ID Practitioner - Physician Assistant 4284082447 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

10583 W Lake Hazel Rd
Boise, ID 83709-6326
Phone (208) 302-5900

10717 W State St
Star, ID 83669-6046
Phone (208) 302-6300

11035 Karcher Rd
Nampa, ID 83651-8200
Phone (208) 302-2100

1150 N Sister Catherine Way
Nampa, ID 83687-3133
Phone (208) 302-7000

215 E Hawaii Ave
Nampa, ID 83686-6011

3025 W Cherry LN
Meridian, ID 83642-8531

6022 W Emerald St
Boise, ID 83704-8855
Phone (208) 367-4603

6094 W Emerald St
Boise, ID 83704-8855
Phone (208) 302-1000

712 Aviation Way
Caldwell, ID 83605-1154
Phone (208) 302-1035

867 S Vanguard Way
Meridian, ID 83642-7552
Phone (208) 302-7950

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jan 1, 2024 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Jan 1, 2024 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Jan 1, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Physician Assistant CurrentSince Jan 1, 2024 Accepting new patients

Locations

910 NW 16th St
Ste 101
Fruitland, ID 83619
Phone (208) 452-8000

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

11035 W Karcher Rd
Nampa, ID 83651
Phone (208) 302-6600

Interoperability endpoints

  • Direct secure messaging: cclark3132882@direct.trinity-health.org

Organizations & group practices 5

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

Hospital & facility affiliations 5

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": "1656115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1104558568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-302-9342",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11035 KARCHER RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836518200",
            "telephone_number": "208-302-6650",
            "fax_number": "208-302-6655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 S 8th Ave Stop 8253",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832090002",
            "country_code": "US",
            "telephone_number": "208-282-4726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "CHRISTINE",
        "middle_name": "DANIELLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-25",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "CLARK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.