Petrie White Family Medicine of Idaho

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M7802 Issued in ID

Legal business name

PETRIE WHITE FAMILY MEDICINE OF IDAHO

Doing business as

Emmett Family Medicine and Direct Primary Care

Practice address

2001 E Quail Run Rd
Emmett, ID 83617-5059

Phone

(208) 365-7131

Fax

(208) 365-4464

NPI assigned

Sep 18, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Ryan Earl White, CRNA

Title

Clinic Administrator

Phone

(208) 365-7131

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Emmett Family Medicine and Direct Primary Care Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 9

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

• Jennifer Petrie, MD

  • Family Medicine Physician
  • Emmett, ID
  • NPI 1891879094
  Medicare reassignment NPD
• Jessica Gates Seick, NP

  • Family Nurse Practitioner
  • Boise, ID
  • NPI 1467049130

  Family Medicine

  Medicare reassignment NPD
• Holly Suzanne Peterson, PA-C

  • Physician Assistant
  • Rexburg, ID
  • NPI 1285278614
  Medicare reassignment
• Isabella M Satterthwait, PA-C

  • Physician Assistant
  • Caldwell, ID
  • NPI 1437625662
  Medicare reassignment
• Hodaka Paul Abe, PA

  • Physician Assistant
  • Caldwell, ID
  • NPI 1013299866
  NPD (past)
• Craig R Jamison, PAC

  • Orthopaedic Surgery Physician
  • Caldwell, ID
  • NPI 1447248141
  NPD (past)
• Michele Miles, PA-C,MS

  • Physician Assistant
  • Emmett, ID
  • NPI 1710011325
  NPD (past)
• John Quentin Smith, MD

  • Orthopaedic Surgery Physician
  • Caldwell, ID
  • NPI 1447249131
  NPD (past)
• Bryce Wikfors, PA-C

  • Physician Assistant
  • Caldwell, ID
  • NPI 1588915292
  NPD (past)

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1447629555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 E QUAIL RUN RD",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836175059",
            "telephone_number": "208-365-7131",
            "fax_number": "208-365-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 E QUAIL RUN RD",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836175059",
            "telephone_number": "208-365-7131",
            "fax_number": "208-365-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRIE WHITE FAMILY MEDICINE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "208-365-7131",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805196400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emmett Family Medicine and Direct Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nutrition Counseling Valerie Lawrence
• Cory Ondler, D.O.
• Melissa Mahcalani Paller, LMSC
• Peterson Orthodontics PLLC
• Kelsey Peterson, DMD
• Jennifer Petrie, MD
• Daniel Michael Pewe, DC
• Debra Anne Phillips, FNP-BC
• Kathryn Margaret Phillips, DPT
• Kirk D Prodzinski, DO

• Family Medicine Physician in Emmett, ID
• Providers in Emmett, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.