Kovic Shane Bailey, DO
Individual provider Active NPI Family Medicine Physician · Twin Falls, ID
NPI 1194467688 · NPPES record last updated Jun 27, 2025
Key facts
- NPI
- 1194467688
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 7771540 (ID)
- Practice address
- 775 Pole Line Rd W
Twin Falls, ID 83301-5814 - Phone
- (208) 814-8000
- Fax
- (208) 733-9402
- NPI assigned
- Apr 13, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Lukes Clinic LLC
Practice addresses (Care Compare)
775 Pole Line Rd W
Twin Falls, ID 83301-5814
Phone (208) 814-1500
Hospital & facility affiliations
- St Lukes Magic Valley Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250725002456 | ID | Practitioner - Family Practice | 2062899222 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7771540 | ID | MD | Family Medicine Physician |
| BP10080618 | TX | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Clinic LLC | Family Medicine | Current |
Accepting new patients |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
775 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000
775 Pole Line Rd W
Ste 105
Twin Falls, ID 83301
746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230
Interoperability endpoints
- kbailey703209@ahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | BP10080618 | TX | |
| Family Medicine Physician | 207Q00000X | 7771540 | ID | Yes |
Addresses
Primary practice location
775 Pole Line Rd W
Twin Falls, ID 83301-5814
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Other practice location 1
11937 US Highway 271
Tyler, TX 75708-3154
Phone (903) 877-7777
Other providers in Twin Falls, ID
- Nicholas Bacciocco
- Back in Balance Chiropractic, LLC
- Back to Basic Living Res.Hab.
- Eric Leon Bailey
- Francine M Bailey
- Nancy W Bailey
- Emmylou Baird
- Susan Baisch
- Bettie Baker
- Deseret Baker
All providers in Twin Falls, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.