Andersen Family Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ANDERSEN FAMILY CARE

Practice address

1494 West Ustick Rd
110
Meridian, ID 83646

Phone

(208) 908-7797

NPI assigned

Sep 23, 2022

Last updated

Sep 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dallin Andersen, PA-CNPI 1851658595

Title

Owner

Phone

(208) 954-0101

Specialties & licenses 1

Addresses

Other names 1

• Andersen Family Care P.L.L.C Former legal business name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 4

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.

• Dallin Andersen, PA-C

  • Physician Assistant
  • Meridian, ID
  • NPI 1851658595
  Medicare reassignment Care Compare group Authorized official
• Bretta Lee Cyr, PA

  • Physician Assistant
  • Meridian, ID
  • NPI 1730916305
  Medicare reassignment Care Compare group
• Lindsay Ann Erstad, PA-C

  • Physician Assistant
  • Meridian, ID
  • NPI 1306168018
  Medicare reassignment Care Compare group
• Raquel Renee Kacin, APRN, FNP-C

  • Family Nurse Practitioner
  • Meridian, ID
  • NPI 1376647909
  NPD (past)

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1124741277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1494 WEST USTICK RD",
            "address_2": "110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-908-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1494 WEST USTICK RD",
            "address_2": "110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-908-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSEN FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-23",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "DALLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-954-0101",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "andersenfamilycare@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1494 West Ustick Rd",
            "address_2": "110",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "83646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Andersen Family Care P.L.L.C",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Alpha Tamir Anders, MD
• Dallin Andersen, PA-C
• Joseph John Andersen, M.S. LMFT
• Amanda Lee Anderson, D.C.
• Amy Rose Anderson, NP
• Autumn Rose Anderson

• Primary Care Clinic/Center in Meridian, ID
• Providers in Meridian, 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 Sep 28, 2022; 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.