Shelby Lidstrom

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60463924 Issued in WA

Practice address

19200 N Kelsey St
Monroe, WA 98272-1431

Phone

(360) 794-7994

NPI assigned

Sep 9, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Shelby A Myers Former name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049

Merit-based Incentive Payment System (MIPS)

Final score

86.65 of 100Reported as apm

Quality

89.26

Promoting interoperability

69.9

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: slidstrom466929@wm.providencedirect.org

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

• Kootenai Health, Inc.

  • Psychiatry Physician
  • Coeur D Alene, ID
  • NPI 1174661151
  Medicare reassignment Care Compare group NPD
• Kootenai Health, Inc.

  • Emergency Medicine Physician
  • Coeur D Alene, ID
  • NPI 1235288655

  Physician Assistant

  Medicare reassignment NPD (past)
• Incyte Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Spokane Valley, WA
  • NPI 1326086745
  NPD
• Kootenai Health, Inc.

  • Community/Retail Pharmacy
  • Hayden, ID
  • NPI 1235986290
  NPD
• Kootenai Health, Inc.

  • Psychiatric Hospital Unit
  • Coeur D Alene, ID
  • NPI 1568567360
  NPD
• Kootenai Health, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Coeur D Alene, ID
  • NPI 1609925023
  NPD

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

• Kootenai Health, Inc.

  • General Acute Care Hospital
  • Coeur D Alene, ID
  • NPI 1992798409
  Care Compare affiliation

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1154722155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-366-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19200 N KELSEY ST",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721431",
            "telephone_number": "360-794-7994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 Lincoln Way Ste 315",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142527",
            "country_code": "US",
            "telephone_number": "208-625-6000",
            "fax_number": "208-625-6001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIDSTROM",
        "first_name": "SHELBY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-09",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2541",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60463924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "MYERS",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samuel Gordon Leftenant, MD
• Jennifer Lenhart-Falcon, LMT
• Nancy Wagner Leonardson, M.A. AND L.M.H.C..
• Monzell L Lewis, CDP
• Scott R Lewis
• Phami Lieu, RDH
• Rachel Amanda Lim, MD
• Kenneth C Lin, M.D.
• Linda Backenstose PS Inc
• Living Well Health Center, LLC

• Physician Assistant in Monroe, WA
• Providers in Monroe, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.