NPIMap

Organization Active NPI

Primary Therapy Source LLC

  • Durable Medical Equipment & Medical Supplies
  • Twin Falls, ID
National Provider Identifier
1104672682
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PRIMARY THERAPY SOURCE LLC
Doing business as
PrimaryTherapySource LLC
Practice address
254 River Vista PL
Twin Falls, ID 83301-3006
Phone
(208) 734-7333
Fax
(208) 734-8350
NPI assigned
Apr 25, 2024
Last updated
Apr 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
Deborah Jan Yingst, PTNPI 1073633848
Title
Managing Member
Phone
(208) 734-7333

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Customized Equipment (DME) 332BC3200X NU

Addresses

Primary practice location

254 River Vista PL
Twin Falls, ID 83301-3006

Mailing address

254 River Vista PL
Twin Falls, ID 83301-3006
Phone (208) 734-7333

Other names 1

  • PrimaryTherapySource LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240206001635 ID DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 7012002702 1 other NPI on this enrollment
Practice locations: Twin Falls, ID

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

733 N Main St
Ste E
Bellevue, ID 83313
Phone (208) 788-0777

224 E Main St
Burley, ID 83318
Phone (208) 647-0184

401 Brockman Loop
Jerome, ID 83338
Phone (208) 734-1394

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1104672682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 RIVER VISTA PL",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013006",
            "telephone_number": "208-734-7333",
            "fax_number": "208-734-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 RIVER VISTA PL",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013006",
            "telephone_number": "208-734-7333",
            "fax_number": "208-734-8350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY THERAPY SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "YINGST",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "JAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-734-7333",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PrimaryTherapySource LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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.