NPIMap

Organization Active NPI

Southern Idaho Therapy Services

  • Physical Therapist
  • Rupert, ID
National Provider Identifier
1275698490
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTHERN IDAHO THERAPY SERVICES
Practice address
1224 8TH St Ste a
Rupert, ID 83350-1527
Phone
(208) 436-9016
Fax
(208) 436-4922
NPI assigned
Dec 27, 2006
Last updated
Nov 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Authorized official

Name
Mrs. Elaine Ford
Title
Office Manager
Phone
(208) 644-6474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1224 8TH St Ste a
Rupert, ID 83350-1527

Mailing address

228 E 100 S
Jerome, ID 83338-6306
Phone (208) 644-6474

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505001331 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294723326 Receives reassigned benefits from 4 practitioners
Practice locations: Rupert, ID

National Provider Directory

National Provider Directory

Locations

1224 8th St
#A
Rupert, ID 83350
Phone (208) 436-9015

Practitioners & affiliated clinicians

Practitioners 6

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": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1275698490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 E 100 S",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833386306",
            "telephone_number": "208-644-6474",
            "fax_number": "208-644-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 8TH ST STE A",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-9016",
            "fax_number": "208-436-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IDAHO THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-644-6474",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rupert, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.