NPIMap

Organization Active NPI

Public Health District 1

  • State or Local Public Health Clinic/Center
  • Hayden, ID
National Provider Identifier
1427616846
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
PUBLIC HEALTH DISTRICT 1
Practice address
8500 North Atlas Road
Hayden, ID 83835-8332
Phone
(208) 415-5100
Fax
(208) 415-5101
NPI assigned
May 31, 2019
Organization subpart
Yes
Parent organization
PUBLIC HEALTH DISTRICT 1As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Mr. Donald Duffy
Title
Director
Phone
(205) 415-5163

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X
State or Local Public Health Clinic/Center 261QP0905X Primary

Addresses

Primary practice location

8500 North Atlas Road
Hayden, ID 83835-8332

Mailing address

8500 North Atlas Road
Hayden, ID 83835-8332
Phone (208) 415-5100

Other names 1

  • Panhandle Health District 1/ Diabetes Prevention Program Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191106001649 ID MDPP Supplier - in-Person MDPP Supplier 7911923016 Practice locations: Hayden, ID; Kellogg, ID; Sandpoint, ID; St Maries, ID; Bonners Ferry, ID

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Public Health District 12 organizations share this tax ID, including this one
Part of
Public Health District 1

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

35 Wildcat Way
Ste A
Kellogg, ID 83837
Phone (208) 786-7474

114 W Riverside Ave
Kellogg, ID 83837
Phone (208) 786-7474

137 N 8th St
St Maries, ID 83861
Phone (208) 245-4556

Practitioners & affiliated clinicians

Practitioners 3

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": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1427616846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8500 NORTH ATLAS ROAD",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358332",
            "telephone_number": "208-415-5100",
            "fax_number": "208-415-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 NORTH ATLAS ROAD",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358332",
            "telephone_number": "208-415-5100",
            "fax_number": "208-415-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH DISTRICT 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUBLIC HEALTH DISTRICT 1",
        "enumeration_date": "2019-05-31",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "205-415-5163",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panhandle Health District 1/ Diabetes Prevention Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.