Family Health Services Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Bellevue, ID
NPI 1245804400 · NPPES record last updated May 26, 2021
Key facts
- NPI
- 1245804400
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FAMILY HEALTH SERVICES CORPORATION
- Practice address
- 621 N Main St
Bellevue, ID 83313-5093 - Phone
- (208) 737-6718
- NPI assigned
- May 13, 2021
- Organization subpart
- No
Authorized official
- Name
- Stacey Blackwood
- Title
- Credentialing Specialist
- Phone
- (208) 737-6718
Other NPIs on the same Medicare enrollment 35
Practitioners 51
-
Tennille Irene Houston, MHE, RD, LD, CDE
-
Karrie Rae Kondel, ARNP
-
John Urrutia, P.A.C
-
Basil Clarence Anderson, M.D.
-
Jesse J Balls, PA-C
-
Jameson Bastow, DO
-
Nicolas A Bregante, PA-C
-
Cathy White Canty, M.D.
-
Allison Cluff, PA-C
-
Keith E Davis, M.D.
-
Matthew David Detemple, D.O.
-
Matthew Duersch, M.D.
-
Cameron Burgess Freeman, PA-C
-
Sarah Rae French, LCSW
-
Barbara Hapayan, NP
-
Craig Hope, FNP-C
-
Elinor Gabriela Johnson, PA-C
-
Jared Brent Keller, P.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Federally qualified health center certification: CCN 131889
- Legal name
- FAMILY HEALTH SERVICES CORPORATION
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 3, 2022
- Last certification
- Mar 3, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 14, 1982 in ID
- Enrollment address
- 621 N Main St
Bellevue, ID 83313-5093
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Aaron J Houston |
W-2 Managing Employee |
Jan 1, 2011 | |
| Chris Wingfield |
W-2 Managing Employee | Jan 1, 2011 | |
| Melody Lefler |
Corporate Director | Feb 1, 2008 | |
| Marta Hernandez |
Corporate Director | Dec 1, 1999 | |
| Bonnie Hoag |
Corporate Director | Mar 22, 2011 |
All facility ownership & control disclosures 21
| Facility | Type | Role | Since |
|---|---|---|---|
| Family Health Services |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 22, 1982 |
| Family Health Services Shoshone |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 22, 1982 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 15, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 15, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 25, 2022 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 20, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 5, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 30, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 21, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 12, 2019 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 29, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 2, 2022 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 12, 2022 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 1, 2023 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 4, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 4, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 25, 2023 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 8, 2024 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 22, 2024 |
| Family Health Services |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 14, 1982 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 14, 1982 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040216000531 | ID | Part B Supplier - Clinic/Group Practice | 7012815038 |
Receives reassigned benefits from 77 practitioners 35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kimberly, ID; Rupert, ID; Shoshone, ID; Twin Falls, ID; Bellevue, ID; Buhl, ID; Burley, ID; Declo, ID… |
| O20220303002631 | ID | Part a Provider - Federally Qualified Health Center (FQHC) | 7012815038 | Practice locations: Bellevue, ID |
National Provider Directory
Locations
1309 Bennett Ave
Burley, ID 83318
Phone (208) 677-5198
114 Pioneer Ct
Jerome, ID 83338
Phone (208) 324-3471
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Mental Health Counselor |
101YM0800X | |||
| Psychologist |
103T00000X | |||
| Cognitive & Behavioral Psychologist |
103TB0200X | |||
| Social Worker |
104100000X | |||
| Clinical Social Worker |
1041C0700X | |||
| Marriage & Family Therapist |
106H00000X | |||
| Dentist |
122300000X | |||
| Dental Hygienist |
124Q00000X | |||
| Registered Dietitian |
133V00000X | |||
| Pharmacist |
183500000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Medical Physician Assistant |
363AM0700X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
621 N Main St
Bellevue, ID 83313-5093
Mailing address
794 Eastland Dr
Twin Falls, ID 83301-6856
Phone (208) 737-6718
Other providers in Bellevue, ID
- Sherry Aanstad
- Bellevue of Cascadia, LLC
- Ginger L. Dattilo
- Family Health Services Corporation
- Family Health Services Corporation
- Elizabeth Farrington
- Rachel Foster
- Patricia Frye
All providers in Bellevue, ID · Federally Qualified Health Center (FQHC) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2021. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.