NPIMap

Organization Active NPI

Palouse Specialty Physicians, P.S.

  • Neurology Physician
  • Moscow, ID
National Provider Identifier
1407499445
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
PALOUSE SPECIALTY PHYSICIANS, P.S.
Practice address
803 S Main St Ste 110
Moscow, ID 83843-2695
Phone
(208) 813-7519
Fax
(208) 813-7524
NPI assigned
Oct 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Sacha L Smith
Title
Director of Operations
Phone
(208) 882-1700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromuscular Medicine (Psychiatry & Neurology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0008X
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

803 S Main St Ste 110
Moscow, ID 83843-2695

Mailing address

PO Box 847
Pullman, WA 99163-0847
Phone (509) 330-5607

Other practice location 1

619 S Washington St Ste 103
Moscow, ID 83843-3063
Phone (208) 813-7519

Other names 1

  • Palouse Neurology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150718000066 ID Part B Supplier - Clinic/Group Practice 0345569166 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moscow, ID

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

803 S Main St
Ste 210
Moscow, ID 83843
Phone (208) 882-1778

619 S Washington St
Ste 103
Moscow, ID 83843
Phone (208) 813-7519

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1407499445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991630847",
            "telephone_number": "509-330-5607",
            "fax_number": "509-334-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S MAIN ST STE 110",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432695",
            "telephone_number": "208-813-7519",
            "fax_number": "208-813-7524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "619 S Washington St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838433063",
            "country_code": "US",
            "telephone_number": "208-813-7519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALOUSE SPECIALTY PHYSICIANS, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-22",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SACHA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "208-882-1700"
    },
    "taxonomies": [
        {
            "code": "2084N0008X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palouse Neurology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palouse Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.