Robert Crouch, DO

Key facts

NPI

1164801692

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

O-1030 (ID)

Practice address

9850 W St Lukes Dr # 329
Nampa, ID 83687-7912

Phone

(208) 514-2509

Fax

(208) 375-2217

NPI assigned

May 29, 2015

Sex

Male

Sole proprietor

No

Organizations & group practices 9

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.

• Full Circle Health, Inc. Federally Qualified Health Center (FQHC) · Boise, ID · NPI 1841490075
  Medicare reassignment Care Compare group NPD ID
• Teton Valley Health Care Inc Rural Health Clinic/Center · Driggs, ID · NPI 1013264183
  Medicare reassignment Care Compare group NPD FAMILY MEDICINE · ID
• Teton Valley Health Care Inc Critical Access Hospital · Driggs, ID · NPI 1477809622
  Medicare reassignment Care Compare group NPD ID
• Teton Valley Health Care, Inc Medicare Defined Swing Bed Hospital Unit · Driggs, ID · NPI 1053669598
  Care Compare group NPD
• Full Circle Health, Inc. Community/Retail Pharmacy · Boise, ID · NPI 1891047791
  Care Compare group
• Teton Valley Health Care, Inc Rural Health Clinic/Center · Victor, ID · NPI 1801143029
  Care Compare group
• Teton Valley Health Care Inc Family Medicine Physician · Driggs, ID · NPI 1316294531
  NPD FAMILY MEDICINE
• Medical Imaging Associates of Idaho Falls, Inc Diagnostic Radiology Physician · Pocatello, ID · NPI 1740225531
  NPD (past)
• St Lukes Regional Medical Center General Acute Care Hospital · Boise, ID · NPI 1770586794
  NPD (past)

Hospital & facility affiliations 2

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

• Teton Valley Health Care Inc Critical Access Hospital · Driggs, ID · NPI 1477809622
  Care Compare affiliation Hospital
• Teton Valley Health Care, Inc Medicare Defined Swing Bed Hospital Unit · Driggs, ID · NPI 1053669598
  Care Compare affiliation Nursing home

Medicare Care Compare profile

Specialty

Family Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Teton Valley Health Care Inc (31 clinicians)
Full Circle Health Inc (106 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Teton Valley Hospital Hospital · Driggs, ID · CCN 131313
• Teton Valley Hospital Nursing home · CCN 13Z313

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rcrouch295146@direct.ochin.org

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 15, 2023.

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1164801692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9850 W ST LUKES DR # 329",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836877912",
            "telephone_number": "208-514-2509",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROUCH",
        "first_name": "ROBERT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-29",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRO-1490",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-1030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164801692",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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