Active NPI
Vincent Fibelstad, PA
- Physician Assistant
- Lewiston, ID
National Provider Identifier
1184762825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-02
- Practice address
- 415 6TH St
Lewiston, ID 83501-2431 - Phone
- (208) 743-2511
- Fax
- (208) 799-5554
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-02 | ID | Primary |
Addresses
Primary practice location
415 6TH St
Lewiston, ID 83501-2431
Mailing address
415 6TH St
Lewiston, ID 83501-2431
Phone (208) 743-2511
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HBNA1 | Other | ID | IDAHO BLUE CROSS |
| 10017690 | Other | ID | REGENCE OF IDAHO |
| 8118705 | Medicaid | WA | |
| 10017689 | Other | ID | REGENCE OF ID URGENT CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-02 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1184762825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 6TH ST",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835012431",
"telephone_number": "208-743-2511",
"fax_number": "208-799-5554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 6TH ST",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835012431",
"telephone_number": "208-743-2511",
"fax_number": "208-799-5554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIBELSTAD",
"first_name": "VINCENT",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-02",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO BLUE CROSS",
"identifier": "HBNA1",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE OF IDAHO",
"identifier": "10017690",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8118705",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE OF ID URGENT CARE",
"identifier": "10017689",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.