NPIMap

Organization Active NPI

Specialized Family Medicine

  • Family Medicine Physician
  • Pocatello, ID
National Provider Identifier
1124197702
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SPECIALIZED FAMILY MEDICINE
Practice address
151 N 4TH Ave
Suite B
Pocatello, ID 83201-6300
Phone
(208) 369-7147
Fax
(208) 416-6522
NPI assigned
Nov 7, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Jordan L Bailey, MDNPI 1225124936
Title
Physician Owner
Phone
(208) 269-7147

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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ID Primary

Addresses

Primary practice location

151 N 4TH Ave
Suite B
Pocatello, ID 83201-6300

Mailing address

151 N 4TH Ave
Suite B
Pocatello, ID 83201-6300
Phone (208) 369-7147

National Provider Directory

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1124197702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N 4TH AVE",
            "address_2": "SUITE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016300",
            "telephone_number": "208-369-7147",
            "fax_number": "208-416-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N 4TH AVE",
            "address_2": "SUITE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016300",
            "telephone_number": "208-369-7147",
            "fax_number": "208-416-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALIZED FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "208-269-7147",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.