Individual provider Active NPI

Alice R. Trabert, F.N.P.

  • Family Nurse Practitioner
  • Jerome, ID
National Provider Identifier
1245229558
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-484A Issued in ID
Practice address
132 5TH Ave W
Suite 1
Jerome, ID 83338-1825
Phone
(208) 814-9800
Fax
(208) 814-9833
NPI assigned
Oct 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-484A ID Primary

Addresses

Primary practice location

132 5TH Ave W
Suite 1
Jerome, ID 83338-1825

Mailing address

PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100512001094 ID Practitioner - Nurse Practitioner 6406984426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

775 Pole Line Rd W
Twin Falls, ID 83301-5814
Phone (208) 814-1500

Hospital & facility affiliations

  • St Luke'S Jerome Hospital, Jerome, ID, CCN 131310
  • St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-484AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Clinic LLC Family Medicine CurrentSince Feb 16, 2014 Accepting new patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients
Family Care Physicians, PA Family Medicine Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

132 5th Ave W
Jerome, ID 83338
Phone (207) 324-4992

132 5th Ave W
Ste 1
Jerome, ID 83338
Phone (208) 814-9800

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1245229558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 5TH AVE W",
            "address_2": "SUITE 1",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833381825",
            "telephone_number": "208-814-9800",
            "fax_number": "208-814-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRABERT",
        "first_name": "ALICE",
        "middle_name": "R.",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-19",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-484A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jerome, ID

Sources for this page

Verify at the official NPI Registry.