NPIMap

Organization Active NPI

Gem State ENT, PLLC

  • General Practice Physician
  • Twin Falls, ID
National Provider Identifier
1215715669
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GEM STATE ENT, PLLC
Practice address
2102 Canyon Plaza Dr
Twin Falls, ID 83301-4513
Phone
(208) 352-7555
Fax
(208) 352-7333
NPI assigned
Sep 18, 2023
Last updated
Apr 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Authorized official

Name
Brooke Freidenberger
Title
Medical Coder
Phone
(208) 858-6008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

2102 Canyon Plaza Dr
Twin Falls, ID 83301-4513

Mailing address

2114 Village Park Ave # 200
Twin Falls, ID 83301-4172
Phone (208) 804-1717

Other practice location 1

314 S River St
Hailey, ID 83333-8851
Phone (208) 352-7555

Other practice location 2

1501 Hiland Ave Ste M
Burley, ID 83318-2688
Phone (208) 352-7555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240123000730 ID Part B Supplier - Clinic/Group Practice 8123470481 Receives reassigned benefits from 7 practitioners
Practice locations: Twin Falls, ID

National Provider Directory

National Provider Directory

Locations

1501 Hiland Ave
Ste M
Burley, ID 83318
Phone (208) 352-7555

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1215715669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 VILLAGE PARK AVE # 200",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014172",
            "telephone_number": "208-804-1717",
            "fax_number": "208-804-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 CANYON PLAZA DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014513",
            "telephone_number": "208-352-7555",
            "fax_number": "208-352-7333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "314 S River St",
            "address_purpose": "LOCATION",
            "city": "Hailey",
            "state": "ID",
            "postal_code": "833338851",
            "country_code": "US",
            "telephone_number": "208-352-7555",
            "fax_number": "208-352-7333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Hiland Ave Ste M",
            "address_purpose": "LOCATION",
            "city": "Burley",
            "state": "ID",
            "postal_code": "833182688",
            "country_code": "US",
            "telephone_number": "208-352-7555",
            "fax_number": "208-352-7333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GEM STATE ENT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "FREIDENBERGER",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "MEDICAL CODER",
        "authorized_official_telephone_number": "208-858-6008"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.