Kirk D Prodzinski, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

O-0600 Issued in ID

Practice address

207 E 12TH St
Emmett, ID 83617-3626

Phone

(208) 365-1065

Fax

(208) 365-1068

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kprodzinski696979@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Family Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Payette, ID
  • NPI 1407886484

  Family Medicine

  Medicare reassignment NPD
• Southern Idaho Health Partners LLC

  • General Practice Physician
  • Meridian, ID
  • NPI 1952701401
  NPD
• Valley Family Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Emmett, ID
  • NPI 1932139995

  Family Medicine

  NPD
• Interpath Laboratory, Inc.

  • Clinical Medical Laboratory
  • Pendleton, OR
  • NPI 1548208440
  NPD (past)
• Valley Family Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Nyssa, OR
  • NPI 1083641310

  Family Medicine

  NPD (past)
• Valley Family Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Ontario, OR
  • NPI 1295415032
  NPD (past)
• Valley Family Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Ontario, OR
  • NPI 1992732291

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1245206648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 NE 10TH AVE",
            "city": "PAYETTE",
            "state": "ID",
            "postal_code": "836615420",
            "telephone_number": "208-642-9376",
            "fax_number": "208-642-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E 12TH ST",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173626",
            "telephone_number": "208-365-1065",
            "fax_number": "208-365-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRODZINSKI",
        "first_name": "KIRK",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "41285",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "42041",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "04555",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kirk.prodzinski@sal.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3077 E Barber Valley Dr",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837164747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Petrie White Family Medicine of Idaho
• Jennifer Petrie, MD
• Daniel Michael Pewe, DC
• Debra Anne Phillips, FNP-BC
• Kathryn Margaret Phillips, DPT
• Sheila Ann Pulley, CPHT
• Patty Ann Puschmann, BI
• Redefined Counseling and Consulting
• Marjorie Colleen Reed, IS
• Desiree Darlene Reid, PA-C

• Family Medicine Physician in Emmett, ID
• Providers in Emmett, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.