Idaho Physical Medicine & Rehabilitation

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

IDAHO PHYSICAL MEDICINE & REHABILITATION

Practice address

600 Robbins Rd
Boise, ID 83702-4539

Phone

(208) 489-4016

Fax

(208) 489-4015

NPI assigned

May 9, 2007

Last updated

Mar 16, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

IDAHO PHYSICAL MEDICINE & REHABILITATIONAs reported in NPPES

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

Authorized official

Name

Ms. Sharon A Lee

Title

Administrator

Phone

(208) 489-5160

Specialties & licenses 1

Addresses

Other names 1

• PA Grp Other name

Tax ID family

William R Prebola Jr MD2 organizations share this tax ID, including this one

Part of

William R Prebola Jr MD

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Idaho Physical Medicine and Rehabilitation PA

  • Ambulatory Surgical Clinic/Center
  • Meridian, ID
  • NPI 1497949705
  NPD tax ID

Locations

Interoperability endpoints

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Idaho Physical Medicine and Rehabilitation PA

  • Physical Medicine & Rehabilitation Physician
  • Meridian, ID
  • NPI 1497711329
  NPPES parent name

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1497969604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N. ROBBINS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-489-4016",
            "fax_number": "208-489-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ROBBINS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024539",
            "telephone_number": "208-489-4016",
            "fax_number": "208-489-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PHYSICAL MEDICINE & REHABILITATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDAHO PHYSICAL MEDICINE & REHABILITATION",
        "enumeration_date": "2007-05-09",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-489-5160",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PA Grp",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Idaho Pain Center
• Idaho Pain Medicine, LLP
• Idaho Pediatric Gastroenterology PA
• Idaho Perio Center for Dental Implants & Laser Periodontal Therapy
• Idaho Pharmacy Retail
• Idaho Pulmonary Associates, PA
• Idaho Radiology Associates PLLC
• Idaho Retina Center PLLC
• Idaho Scoliosis Specialists PLLC
• Idaho Shoulder to Hand Specialists PC

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; 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.