Active NPI
Natalie A Domangue-Shiflett, MD
- Family Medicine Physician
- Meridian, ID
National Provider Identifier
1376510123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M-9985
- Practice address
- 4740 N Penngrove Way
Ste 100
Meridian, ID 83646 - Phone
- (208) 938-3663
- Fax
- (208) 938-3664
- NPI assigned
- Mar 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M-9985 | ID | Primary |
Addresses
Primary practice location
4740 N Penngrove Way
Ste 100
Meridian, ID 83646
Mailing address
4740 N Penngrove Way
Ste 100
Meridian, ID 83646
Phone (208) 938-3663
Other practice location 1
4740 N Penngrove Way
Ste 100
Meridian, ID 83646
Phone (208) 965-0905
Other practice location 2
500 W Fort St
Boise, ID 83702-4501
Phone (208) 422-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H36269 | Medicaid | ID |
Other names 1
- Natalie A Shiflett
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Louisiana State University School of Medicine in New Orleans, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4740 N Penngrove Way
Suite 100
Meridian, ID 83646-7446
Phone (208) 938-3663
Hospital & facility affiliations
- Idaho Home Health & Hospice
- Aspen Home Care and Hospice
- Arbor Valley of Cascadia
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pioneer Family Medicine PLLC | Family Medicine | Current | Accepting new patients |
Locations
13150 W Persimmon Ln
Boise, ID 83713
Phone (208) 510-9890
4740 N Penngrove Way
Ste 100
Meridian, ID 83646
Phone (208) 938-3663
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FBBGCA
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Meridian, ID
- NPI 1952335929
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Community Based Hospice Care Agency
- Twin Falls, ID
- NPI 1730407701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664928000000",
"number": "1376510123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4740 N PENNGROVE WAY",
"address_2": "STE 100",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "83646",
"telephone_number": "208-938-3663",
"fax_number": "208-938-3664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 N PENNGROVE WAY",
"address_2": "STE 100",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "83646",
"telephone_number": "208-938-3663",
"fax_number": "208-938-3664"
}
],
"practiceLocations": [
{
"address_1": "4740 N Penngrove Way",
"address_2": "Ste 100",
"address_purpose": "LOCATION",
"city": "Meridian",
"state": "ID",
"postal_code": "83646",
"country_code": "US",
"telephone_number": "208-965-0905",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "500 W Fort St",
"address_purpose": "LOCATION",
"city": "Boise",
"state": "ID",
"postal_code": "837024501",
"country_code": "US",
"telephone_number": "208-422-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOMANGUE-SHIFLETT",
"first_name": "NATALIE",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M-9985",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "H36269",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "NATALIE",
"last_name": "SHIFLETT",
"middle_name": "A",
"credential": "MD",
"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 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.