NPIMap

Organization Active NPI

Ieg Zenergy, LLC

Doing business as Zenergy Sports Rehabilitation Clinic

  • Specialist
  • Ketchum, ID
National Provider Identifier
1346698701
Registry record updated May 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
IEG ZENERGY, LLC
Doing business as
Zenergy Sports Rehabilitation Clinic
Practice address
245 Raven Rd
Suite B
Ketchum, ID 83340
Phone
(208) 726-7246
Fax
(208) 726-8911
NPI assigned
May 26, 2016
Last updated
May 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2016

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

Authorized official

Name
Mr. Derek Agnew
Title
General Manager
Phone
(208) 725-5384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

245 Raven Rd
Suite B
Ketchum, ID 83340

Mailing address

PO Box 1363
Ketchum, ID 83340-1363
Phone (208) 726-7246

Other names 1

  • Zenergy Sports Rehabilitation Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161031002074 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830477587 Receives reassigned benefits from 8 practitioners
Practice locations: Ketchum, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1346698701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1363",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833401363",
            "telephone_number": "208-726-7246",
            "fax_number": "208-726-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 RAVEN RD",
            "address_2": "SUITE B",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-726-7246",
            "fax_number": "208-726-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IEG ZENERGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "AGNEW",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "208-725-5384",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Zenergy Sports Rehabilitation Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ketchum, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.