Desiree Darlene Reid, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1597 Issued in ID

Practice address

1102 E Locust St
Emmett, ID 83617-2713

Phone

(208) 365-6004

NPI assigned

Feb 19, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Jonathan Barrus DO PC

  dba Gem Family Medicine

  • Family Medicine Physician
  • Emmett, ID
  • NPI 1699375659
  Medicare reassignment

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1427558154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 EAGLE HILLS WAY",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165216",
            "telephone_number": "208-409-9471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 E LOCUST ST",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836172713",
            "telephone_number": "208-365-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REID",
        "first_name": "DESIREE",
        "middle_name": "DARLENE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-19",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirk D Prodzinski, DO
• Sheila Ann Pulley, CPHT
• Patty Ann Puschmann, BI
• Redefined Counseling and Consulting
• Marjorie Colleen Reed, IS
• Kirk Robbins
• Derek L Rodigo
• Kimberly M Roller
• Shon Dewane Rooks, D.D.S.
• Morgan Riley Ruiz, DO

• Physician Assistant in Emmett, ID
• Providers in Emmett, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.