NPIMap

Organization Active NPI

Mind Matters LLC

  • Multi-Specialty Clinic/Center
  • Coeur d'Alene, ID
National Provider Identifier
1376160820
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MIND MATTERS LLC
Practice address
1875 N Lakewood Dr Ste 101
Coeur D Alene, ID 83814-4928
Phone
(208) 719-9110
NPI assigned
Jul 1, 2020
Last updated
Oct 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Authorized official

Name
James Smidt
Title
Owner
Phone
(855) 621-8250

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Professional Counselor 101YP2500X NU

Addresses

Primary practice location

1875 N Lakewood Dr Ste 101
Coeur D Alene, ID 83814-4928

Mailing address

1875 N Lakewood Dr Ste 101
Coeur D Alene, ID 83814-4928
Phone (208) 719-9110

Other practice location 1

8382 N Wayne Dr Ste 103B
Hayden, ID 83835-6028
Phone (855) 621-8250

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201123000000 ID Part B Supplier - Clinic/Group Practice 5890106918 Receives reassigned benefits from 8 practitioners
Practice locations: Hayden, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1593561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1376160820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 N LAKEWOOD DR STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144928",
            "telephone_number": "208-719-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 N LAKEWOOD DR STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144928",
            "telephone_number": "208-719-9110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8382 N Wayne Dr Ste 103B",
            "address_purpose": "LOCATION",
            "city": "Hayden",
            "state": "ID",
            "postal_code": "838356028",
            "country_code": "US",
            "telephone_number": "855-621-8250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIND MATTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-01",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "SMIDT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-621-8250"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; 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.