North Idaho Pain Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

13C0001058 Issued in ID

Legal business name

NORTH IDAHO PAIN CENTER LLC

Practice address

1686 W Riverstone Dr Ste 2
Coeur D Alene, ID 83814-5779

Phone

(208) 765-4807

Fax

(208) 765-2903

NPI assigned

Jan 26, 2006

Organization subpart

No

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

Authorized official

Name

Tina Marie Botai

Title

Practice Administrator

Phone

(208) 765-4807

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Listed as

North Idaho Pain Center LLCCCN 13C0001058

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Karl Magnuson, MD

  • Pain Medicine (Anesthesiology) Physician
  • Coeur D Alene, ID
  • NPI 1174593404
  NPD (past)
• Clinton M Thome, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Coeur D Alene, ID
  • NPI 1558654756
  NPD (past)

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1104896422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1686 W RIVERSTONE DR",
            "address_2": "STE 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145779",
            "telephone_number": "208-765-4807",
            "fax_number": "208-765-2903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 W RIVERSTONE DR STE 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145779",
            "telephone_number": "208-765-4807",
            "fax_number": "208-765-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH IDAHO PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "BOTAI",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "208-765-4807"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ID",
            "license": "13C0001058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Idaho Medical Care Centers
• North Idaho Medical Care Centers PLLC
• North Idaho Mental Health Assoc
• North Idaho Mobile OT
• North Idaho MRI
• North Idaho Psychiatry LLC
• North Idaho Ranch Recovery Clinic
• North Idaho Treatment Associates
• North Idaho Urology, PLLC
• North Idaho Weight Loss, LLC.

• Ambulatory Surgical Clinic/Center in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.