NPIMap

Organization Active NPI

Root Cause Integrative Medicine LLC

  • Family Medicine Physician
  • Ammon, ID
National Provider Identifier
1447718853
Registry record updated Apr 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROOT CAUSE INTEGRATIVE MEDICINE LLC
Practice address
1547 S Midway Ave
Suite B
Ammon, ID 83406
Phone
(208) 497-0429
Fax
(208) 497-0430
NPI assigned
Mar 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2019

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

Authorized official

Name
Mr. Jordan Neil Hale, PA-CNPI 1396110169
Title
Co-Owner/ Physician Assistant
Phone
(650) 933-6384

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: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1547 S Midway Ave
Suite B
Ammon, ID 83406

Mailing address

1547 S Midway Ave
Suite B
Ammon, ID 83406
Phone (208) 497-0429

Other identifiers 1

IdentifierTypeStateIssuer
1396110169MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190401001206 ID Part B Supplier - Clinic/Group Practice 2062753098 Receives reassigned benefits from 5 practitioners
Practice locations: Ammon, ID

National Provider Directory

National Provider Directory

Locations

1547 Midway Ave
#B
Ammon, ID 83406
Phone (208) 360-6770

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JEJHBD

Practitioners & affiliated clinicians

Practitioners 5

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": "1551744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554854400000",
    "number": "1447718853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 S MIDWAY AVE",
            "address_2": "SUITE B",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "83406",
            "telephone_number": "208-497-0429",
            "fax_number": "208-497-0430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 S MIDWAY AVE",
            "address_2": "SUITE B",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "83406",
            "telephone_number": "208-497-0429",
            "fax_number": "208-497-0430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOT CAUSE INTEGRATIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-04-10",
        "status": "A",
        "authorized_official_last_name": "HALE",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "CO-OWNER/ PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "650-933-6384",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396110169",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 10, 2019; 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.