Greene Mountain Medical

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GREENE MOUNTAIN MEDICAL

Practice address

3719 Wheeler Cir
Nampa, ID 83686-7949

Phone

(208) 695-0388

Fax

(208) 606-3682

NPI assigned

May 22, 2023

Organization subpart

No

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

Authorized official

Name

Aimee Elizabeth Shepard, FNPNPI 1154092427

Title

Owner

Phone

(208) 695-0388

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

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

• Aimee Elizabeth Shepard, FNP-C

  • Family Nurse Practitioner
  • Nampa, ID
  • NPI 1154092427
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1124710009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 WHEELER CIR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836867949",
            "telephone_number": "208-695-0388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 WHEELER CIR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836867949",
            "telephone_number": "208-695-0388",
            "fax_number": "208-606-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE MOUNTAIN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "AIMEE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-695-0388",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Siobhan Green, MED
• Kathryn T. Green, LCPC
• Koryl Green
• Lawrence E Green, M.D.
• Ryan G Greenberg
• Austin James Greene, PT, DPT
• Hannah Joy Greene, CPM
• Karen Greenwall
• Annie Greenwood, MS
• Breanna Greer

• Primary Care Clinic/Center in Nampa, ID
• Providers in Nampa, ID by specialty
• Primary Care Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.