Individual provider Active NPI

Samuel Shinkle, PA-C

  • Physician Assistant
  • Eagle, ID
National Provider Identifier
1558735514
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1318 Issued in ID
Practice address
435 S Eagle Rd
Eagle, ID 83616-6067
Phone
(208) 939-8200
Fax
(208) 939-8222
NPI assigned
Nov 13, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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-1318 ID Primary

Addresses

Primary practice location

435 S Eagle Rd
Eagle, ID 83616-6067

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6522

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
I20151204000619 ID Practitioner - Physician Assistant 0143520650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians

Practice addresses (Care Compare)

10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500

1474 N Meridian Rd
Kuna, ID 83634-2041
Phone (208) 809-2885

1475 N Cole Rd
Boise, ID 83704-8537
Phone (208) 809-2880

1623 S Wells Ave
Meridian, ID 83642-5040
Phone (208) 489-1450

1820 Caldwell Blvd
Nampa, ID 83651-1505
Phone (208) 466-6567

1895 McGrath Rd
Eagle, ID 83616-6243
Phone (208) 939-8200

1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860

512 N 21St Ave
Caldwell, ID 83605-4368
Phone (208) 809-2875

8971 W Overland Rd
Boise, ID 83709-1651
Phone (208) 378-4288

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC Family Medicine Current Accepting new patients
Alliance Medical Group, LLC Family Medicine CurrentSince Nov 16, 2015 Accepting new patients

Locations

8971 W Overland Rd
Boise, ID 83709
Phone (208) 378-4288

11197 W Fairview Ave
Boise, ID 83713
Phone (208) 378-8011

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

435 S Eagle Rd
Eagle, ID 83616
Phone (208) 939-8200

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

5601 W Chinden Blvd
Garden City, ID 83714
Phone (208) 809-2865

1900 W Chinden Blvd
Meridian, ID 83646
Phone (208) 809-2860

1648 NW 1st St
Meridian, ID 83642
Phone (208) 888-9393

Interoperability endpoints

  • Direct secure messaging: samuel.shinkle@phmg.eclinicaldirectplus.com

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 8

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": "1447372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1558735514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6522",
            "fax_number": "208-955-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 S EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166067",
            "telephone_number": "208-939-8200",
            "fax_number": "208-939-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINKLE",
        "first_name": "SAMUEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-13",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.