Kelly Page Palmer, D.O.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

O-144 Issued in ID

Practice address

700 East Alice Street
Blackfoot, ID 83221-0400

Phone

(208) 785-8517

Fax

(208) 785-8516

NPI assigned

Dec 29, 2006

Last updated

Aug 14, 2012By 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 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoshone Bannock Tribes, IncGroup PAC ID 5496804429, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Shoshone Bannock Tribes, Inc

  dba Shoshone-Bannock Community Health Center

  • Clinic/Center
  • Fort Hall, ID
  • NPI 1225414519

  TX

  Medicare reassignment Care Compare group
• Canvi Behavioral Health PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chubbuck, ID
  • NPI 1144984873
  Medicare reassignment NPD
• Portneuf Valley Family Center

  • Professional Counselor
  • Pocatello, ID
  • NPI 1174629976
  Medicare reassignment NPD
• Shoshone-Bannock Community Health Center

  dba Shoshone-Bannock Tribes

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Fort Hall, ID
  • NPI 1225570716
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344902400000",
    "number": "1184780694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "address_2": "700 EAST ALICE",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832210400",
            "telephone_number": "208-785-8517",
            "fax_number": "208-785-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 EAST ALICE STREET",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832210400",
            "telephone_number": "208-785-8517",
            "fax_number": "208-785-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "KELLY",
        "middle_name": "PAGE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2012-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ID",
            "license": "O-144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003398400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0033991",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn B Ostler, M.D.
• Brent Stanley Packer, BS
• Packham Insurance Agency
• Palma Family Practice LLC
• Catlin A Palmer, LCSW
• Parkway Surgery Center LLC
• Parkway Surgery Center LLC
• Julene M Parson
• Roshan S Patel, M.D.
• Peak Family Medicine, LLC

• Child & Adolescent Psychiatry Physician in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Child & Adolescent Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.