Individual provider Active NPI

Kristen Pace

  • Physician Assistant
  • Fruitland, ID
National Provider Identifier
1497419436
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-2136 Issued in ID
Practice address
1210 NW 16TH St
Fruitland, ID 83619-2202
Phone
(208) 452-8600
Fax
(208) 452-8601
NPI assigned
Oct 26, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-2136 ID Primary

Addresses

Primary practice location

1210 NW 16TH St
Fruitland, ID 83619-2202

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

4971 W Overland Rd
Boise, ID 83705-2822
Phone (208) 472-5050

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20211117003075 ID Practitioner - Physician Assistant 0345639084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

1210 NW 16TH St
Fruitland, ID 83619-2202
Phone (208) 452-8600

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

701 E Parkcenter Blvd
Boise, ID 83706-6528
Phone (208) 381-6500

9580 W St Lukes Dr
Nampa, ID 83687-7912
Phone (208) 505-2711

9850 St Lukes Dr
Nampa, ID 83687-7912

9850 W St Luke'S Dr
Nampa, ID 83687-7912

Hospital & facility affiliations

  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Merit-based Incentive Payment System (MIPS)

Final score
84.87 of 100Reported as group
Quality
77.29
Promoting interoperability
97
Improvement activities
40
Cost
74.78

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-2136IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Family Medicine CurrentSince Jun 25, 2024 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

701 E Parkcenter Blvd
Boise, ID 83706
Phone (208) 381-6400

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

701 E Parkcenter Blvd
Ste 129
Boise, ID 83706

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

3101 E State St
Ste 129
Eagle, ID 83616

3101 E State St
Ste 1100
Eagle, ID 83616
Phone (208) 473-3500

1210 NW 16th St
Ste 129
Fruitland, ID 83619

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

840 N 4th E
Mountain Home, ID 83647
Phone (208) 587-1850

840 N 4th E
Ste 129
Mountain Home, ID 83647

9850 W St Lukes Dr
Ste 129
Nampa, ID 83687
Phone (208) 205-7600

9850 W St Lukes Dr
Nampa, ID 83687
Phone (208) 205-7282

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1497419436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 NW 16TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192202",
            "telephone_number": "208-452-8600",
            "fax_number": "208-452-8601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4971 W Overland Rd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837052822",
            "country_code": "US",
            "telephone_number": "208-472-5050",
            "fax_number": "208-472-5051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACE",
        "first_name": "KRISTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-26",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fruitland, ID

Sources for this page

Verify at the official NPI Registry.