NPIMap

Organization Active NPI

Addi

Doing business as ADD Clinic of Idaho

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1326877762
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ADDI
Doing business as
ADD Clinic of Idaho
Practice address
1526 W Ustick Rd Ste 110
Meridian, ID 83646-7741
Phone
(208) 370-5888
NPI assigned
Aug 1, 2024
Last updated
Oct 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MERIDIAN ADVANCED PSYCHIATRY , LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Authorized official

Name
Kyle Ronnau, NP, PMHNPNPI 1326584640
Title
Ceo/Medical Director
Phone
(208) 515-2273

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

1526 W Ustick Rd Ste 110
Meridian, ID 83646-7741

Mailing address

1672 S Woodsage Ave
Meridian, ID 83642-8329
Phone (208) 515-2273

Other names 2

  • ADD Clinic of Idaho Doing business as
  • ADDI, LLC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241016004231 ID Part B Supplier - Clinic/Group Practice 5496287393 Receives reassigned benefits from 7 practitioners
Practice locations: Meridian, ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2284741Add Clinic of Idaho1526 W Ustick Rd Unit 110, Meridian, ID 83646Certificate of waiverJun 27, 2027

National Provider Directory

National Provider Directory
Part of
Meridian Advanced Psychiatry LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1526 W Ustick Rd
Ste 110
Meridian, ID 83646
Phone (208) 370-5888

1672 S Woodsage Ave
Meridian, ID 83642
Phone (208) 515-2273

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1326877762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1672 S WOODSAGE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428329",
            "telephone_number": "208-515-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 W USTICK RD STE 110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467741",
            "telephone_number": "208-370-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERIDIAN ADVANCED PSYCHIATRY , LLC",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "RONNAU",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "208-515-2273",
        "authorized_official_credential": "NP, PMHNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADD Clinic of Idaho",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADD Clinic of Idaho",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADDI, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.