NPIMap

Organization Active NPI

Idaho Physical Medicine and Rehabilitation PA

  • Physical Medicine & Rehabilitation Physician
  • Meridian, ID
National Provider Identifier
1497711329
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
IDAHO PHYSICAL MEDICINE AND REHABILITATION PA
Practice address
3551 E. Overland Rd.
Meridian, ID 83642
Phone
(208) 884-1333
Fax
(208) 489-4015
NPI assigned
Apr 20, 2006
Last updated
Jan 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Tiffany Mecham
Title
Administrator
Phone
(208) 884-1333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X ID Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2081P2900X ID

Addresses

Primary practice location

3551 E. Overland Rd.
Meridian, ID 83642

Mailing address

PO Box 1128
Boise, ID 83701
Phone (208) 884-1333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040909001424 ID Part B Supplier - Clinic/Group Practice 3971579954 Receives reassigned benefits from 13 practitioners
Practice locations: Boise, ID; Meridian, ID; Mountain Home, 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

Locations

161 E Mallard Dr
Boise, ID 83706
Phone (208) 203-2781

1000 State St
McCall, ID 83638
Phone (208) 634-2221

520 S Eagle Rd
Ste 2110
Meridian, ID 83642
Phone (208) 489-4016

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1497711329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1128",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83701",
            "telephone_number": "208-884-1333",
            "fax_number": "208-489-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 E. OVERLAND RD.",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-884-1333",
            "fax_number": "208-489-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PHYSICAL MEDICINE AND REHABILITATION PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "MECHAM",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-884-1333"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ID",
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "ID",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; 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.