Derek Scott Ahlstrom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1715 Issued in ID

Practice address

7941 W Rifleman St
Boise, ID 83704-9001

Phone

(208) 895-7950

NPI assigned

Jan 8, 2019

Last updated

Mar 28, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Lifeways, Inc

  • Community/Behavioral Health Agency
  • Ontario, OR
  • NPI 1568558955

  ID

  Medicare reassignment
• Ashwood Recovery LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boise, ID
  • NPI 1043545106
  NPD (past)
• Ashwood Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Boise, ID
  • NPI 1801452677
  NPD (past)
• Northpoint Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Meridian, ID
  • NPI 1154709087
  NPD (past)
• Evergreen at Northpoint LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Seattle, WA
  • NPI 1942735667
  NPD (past)
• Northpoint Washington LLC

  • Substance Abuse Rehabilitation Facility
  • Edmonds, WA
  • NPI 1891292900
  NPD (past)

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1174096606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 S TOPAZ WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424474",
            "telephone_number": "208-605-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7941 W RIFLEMAN ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049001",
            "telephone_number": "208-895-7950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9292 W Barnes Dr",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837091554",
            "country_code": "US",
            "telephone_number": "208-795-3515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6600 W Emerald St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837048738",
            "country_code": "US",
            "telephone_number": "208-609-9020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2335 E State Ave",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836428808",
            "country_code": "US",
            "telephone_number": "208-672-1801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "924 S Pines Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "992065423",
            "country_code": "US",
            "telephone_number": "509-299-8160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2111 N Northgate Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981339018",
            "country_code": "US",
            "telephone_number": "425-502-9945",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2111 N Northgate Way Ste 101",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981339018",
            "country_code": "US",
            "telephone_number": "206-309-3740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7416 212th St SW",
            "address_purpose": "LOCATION",
            "city": "Edmonds",
            "state": "WA",
            "postal_code": "980267602",
            "country_code": "US",
            "telephone_number": "425-245-5800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "847 Parkcentre Way Ste 7",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836511794",
            "country_code": "US",
            "telephone_number": "208-229-6050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AHLSTROM",
        "first_name": "DEREK",
        "middle_name": "SCOTT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-08",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61522965",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Ahlers, M.D.
• Alexandria Ahlm, DO
• J Thomas Ahlquist, MD
• Tom C Ahlrichs, LCSW
• Danielle Rae Ahlstrom
• Parwiz Ahmad
• Farkhunda Ahmadi, FNP
• Tara S Ahmed
• Melanie R Ahrens, CRNA
• Aidaly Care Idaho LLC (Aidaly Care)

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.