NPIMap

Organization Active NPI

Fortify Optimal Health

  • Family Medicine Physician
  • Ammon, ID
National Provider Identifier
1437945391
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FORTIFY OPTIMAL HEALTH
Practice address
1189 Red Robin Ave
Ammon, ID 83401-5747
Phone
(619) 602-4520
NPI assigned
Apr 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Authorized official

Name
Susannah Hancock, FNPNPI 1164973053
Title
Ceo
Phone
(619) 602-4520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1189 Red Robin Ave
Ammon, ID 83401-5747

Mailing address

784 South Clear Loop Ste R
Post Falls, ID 83854
Phone (619) 602-4520

Other names 1

  • FORTIFY OPTIMAL HEALTH Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1744848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744848000000",
    "number": "1437945391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 SOUTH CLEAR LOOP STE R",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "83854",
            "telephone_number": "619-602-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1189 RED ROBIN AVE",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834015747",
            "telephone_number": "619-602-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTIFY OPTIMAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-17",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "SUSANNAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-602-4520",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORTIFY OPTIMAL HEALTH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ammon, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.