NPIMap

Individual provider Active NPI

Kimberly Tenold, PA-C

  • Medical Physician Assistant
  • Hailey, ID
National Provider Identifier
1144240268
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-2160 Issued in ID
Practice address
1450 Aviation Dr Ste 203
Hailey, ID 83333-8785
Phone
(208) 727-8295
NPI assigned
Jul 20, 2006
Last updated
May 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 102487 NC
Physician Assistant 363A00000X 102487 NC
Medical Physician Assistant 363AM0700X PA-2160 ID Primary

Addresses

Primary practice location

1450 Aviation Dr Ste 203
Hailey, ID 83333-8785

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211115000563 ID Practitioner - Physician Assistant 3779628870 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic - Wood River LLCGroup PAC ID 3173783818, 66 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Ketchum, ID 83340

1450 Aviation Dr
Hailey, ID 83333-8785

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.05 of 100Reported as group
Quality
91.8
Promoting interoperability
100
Improvement activities
40
Cost
61.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
102487NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Services Corporation CurrentSince Nov 9, 2021 Accepting new patients
Family Health Services Corporation CurrentSince Nov 9, 2021 Accepting new patients
Charlotte Medical Clinic Inc Internal Medicine Past Accepting new patients

Locations

388 Martin St
Twin Falls, ID 83301
Phone (208) 734-0451

794 Eastland Dr
Twin Falls, ID 83301
Phone (208) 734-3312

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1144240268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 AVIATION DR STE 203",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338785",
            "telephone_number": "208-727-8295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENOLD",
        "first_name": "KIMBERLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "102487",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102487",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-2160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hailey, ID

Sources for this page

Verify at the official NPI Registry.