NPIMap

Organization Active NPI

Community Care West Side LLC

  • Family Medicine Physician
  • Idaho Falls, ID
National Provider Identifier
1295009785
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY CARE WEST SIDE LLC
Practice address
765 S Utah Ave
Idaho Falls, ID 83402-5093
Phone
(208) 525-2600
Fax
(208) 525-2611
NPI assigned
Feb 29, 2012
Last updated
Apr 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

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

Authorized official

Name
Heather McVey, CPC
Title
Office Manager
Phone
(208) 525-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

765 S Utah Ave
Idaho Falls, ID 83402-5093

Mailing address

765 S Utah Ave
Idaho Falls, ID 83402-5093
Phone (208) 525-2600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120703000554 ID Part B Supplier - Clinic/Group Practice 3678738218 Receives reassigned benefits from 70 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 72

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.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1295009785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 S UTAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834025093",
            "telephone_number": "208-525-2600",
            "fax_number": "208-525-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 S UTAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834025093",
            "telephone_number": "208-525-2600",
            "fax_number": "208-525-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE WEST SIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "MCVEY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-525-2600",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; 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.