NPIMap

Organization Active NPI

Benewah Community Hospital

Doing business as St Maries Family Medicine

  • Rural Health Clinic/Center
  • St Maries, ID
National Provider Identifier
1386632180
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BENEWAH COMMUNITY HOSPITAL
Doing business as
St Maries Family Medicine
Practice address
229 S 7TH St Ste 101 & 300
St Maries, ID 83861-1803
Phone
(208) 245-2591
Fax
(208) 245-5246
NPI assigned
Oct 6, 2005
Last updated
Sep 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BENEWAH COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Ms. Lori Minier
Title
Cfo
Phone
(208) 245-7609

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

229 S 7TH St Ste 101 & 300
St Maries, ID 83861-1803

Mailing address

229 S 7TH St
St Maries, ID 83861-1803
Phone (208) 245-2591

Other names 1

  • St Maries Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040927000265 ID Part B Supplier - Clinic/Group Practice 1850200700 Receives reassigned benefits from 62 practitioners
2 other NPIs on this enrollment
Practice locations: St Maries, ID
O20050503001403 ID Part A Provider - Rural Health Clinic 1850200700 Practice locations: St Maries, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386632180. Details of each certification follow.

Rural health clinic certification: CCN 138503

Legal name
BENEWAH COMMUNITY HOSPITAL
Doing business as
ST MARIES FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 27, 2002
Last certification
Mar 27, 2002
Ownership / control type
1B
Organization structure
OtherNon-profit
Enrollment address
229 S 7TH St
Ste 101 & 300
St Maries, ID 83861-1803
Related CCNs
131317

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
13D2279674St Maries Family Medicine229 S 7TH St Ste 300, St Maries, ID 83861Certificate of waiverApr 4, 2027
13D2314001St Maries Family Medicine SM Quick Care229 S 7TH St Ste 101, St Maries, ID 83861Certificate of waiverNov 11, 2026

National Provider Directory

National Provider Directory
Part of
Benewah Com Hosp DME

Locations

229 S 7th St
Fl 1
St Maries, ID 83861
Phone (208) 245-7079

229 S 7th St
Fl 3
St Maries, ID 83861

229 S 7th St
Fl 4
St Maries, ID 83861
Phone (208) 245-7629

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/e8b4f872-6ea1-4b26-a974-041b5fb4c57b/

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lori Minier Individual Corporate Director Dec 23, 2007
W-2 Managing Employee Dec 23, 2007
Benewah Community Hospital Organization, St Maries, ID Operational/Managerial Control May 10, 2007
County of Benewah Organization, St Maries, ID 5% Or Greater Direct Ownership Interest Jan 1, 1966

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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 68

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 68

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1386632180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 S 7TH ST",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838611803",
            "telephone_number": "208-245-2591",
            "fax_number": "208-245-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 S 7TH ST STE 101 & 300",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838611803",
            "telephone_number": "208-245-2591",
            "fax_number": "208-245-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEWAH COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BENEWAH COMMUNITY HOSPITAL",
        "enumeration_date": "2005-10-06",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "MINIER",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-245-7609",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Maries Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Maries, ID

Sources for this page

Verify at the official NPI Registry.