Organization Active NPI

Summit Medical Providers LLC

  • General Practice Physician
  • Eagle, ID
National Provider Identifier
1164397410
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SUMMIT MEDICAL PROVIDERS LLC
Practice address
2205 E Riverside Dr
Eagle, ID 83616-7620
Phone
(801) 867-9760
Fax
(801) 880-4400
NPI assigned
Oct 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Authorized official

Name
Rachel FletcherNPI 1679143150
Title
Owner
Phone
(801) 867-9760

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
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2205 E Riverside Dr
Eagle, ID 83616-7620

Mailing address

2205 E Riverside Dr
Eagle, ID 83616-7620
Phone (801) 867-9760

National Provider Directory

National Provider Directory

Locations

2205 E Riverside Dr
Eagle, ID 83616
Phone (801) 867-9760

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": "1759795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759795200000",
    "number": "1164397410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 E RIVERSIDE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167620",
            "telephone_number": "801-867-9760",
            "fax_number": "801-880-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 E RIVERSIDE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167620",
            "telephone_number": "801-867-9760",
            "fax_number": "801-880-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-07",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-867-9760"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; 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.