Rathdrum Clinic, Inc.

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

M8126 Issued in ID

Legal business name

RATHDRUM CLINIC, INC.

Doing business as

Restored Horizons

Practice address

913 W Canfield Ave
Coeur D Alene, ID 83815-9764

Phone

(208) 819-7103

Fax

(208) 719-0050

NPI assigned

Apr 19, 2013

Organization subpart

No

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

Authorized official

Name

Michael Whiting, MDNPI 1598796708

Title

Owner

Phone

(208) 819-7103

Specialties & licenses 1

Addresses

Other names 1

• Restored Horizons Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Rathdrum Clinic, Inc.

  • Family Medicine Physician
  • Rathdrum, ID
  • NPI 1669572780

  O20040928000528

  Same enrollment

Locations

Practitioners 2

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

• Michael David Whiting, M.D.

  • Family Medicine Physician
  • Coeur D Alene, ID
  • NPI 1598796708
  Medicare reassignment Authorized official
• Lesley Susanne Roberts, PA-C

  • Medical Physician Assistant
  • Coeur D Alene, ID
  • NPI 1568695062
  Medicare reassignment NPD

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

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1538503693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 W CANFIELD AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159764",
            "telephone_number": "208-819-7103",
            "fax_number": "208-719-0050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 W CANFIELD AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159764",
            "telephone_number": "208-819-7103",
            "fax_number": "208-719-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RATHDRUM CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "WHITING",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-819-7103",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "ID",
            "license": "M8126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restored Horizons",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Restored Horizons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandi R Randles
• Kerissa Ransbury
• Benjamin Norman Jens Rasmussen, DDS
• Stanley K Rasmussen, DDS
• Elizabeth Rose Rate
• Elizabeth M Rau, M.D.
• Thomas R Rau, MD
• Joshua Michael Raybell, LCPC
• Katherine B. Ream
• Navara Reardon, LMSW

• Addiction Medicine (Family Medicine) Physician in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Addiction Medicine (Family Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.