Issc Fruitland

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ISSC FRUITLAND

Practice address

975 NW 16TH St.
Fruitland, ID 83619

Phone

(208) 452-7450

Fax

(208) 452-7550

NPI assigned

Mar 24, 2022

Organization subpart

Yes

Parent organization

IDAHO SKIN SURGERY CENTER, PCAs reported in NPPES

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

Authorized official

Name

Celia Ramos

Title

Practice Manager

Phone

(208) 452-7450

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Idaho Skin Surgery Center PC

Locations

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 Skin Surgery Center, PC

  • Dermatology Physician
  • Boise, ID
  • NPI 1295908127
  NPPES parent name

Practitioners 4

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.

• Brittney Irons, FNP

  • Family Nurse Practitioner
  • Fruitland, ID
  • NPI 1386103760
  Medicare reassignment Care Compare group NPD
• Jeanna Rae Rendo, NP-C

  • Nurse Practitioner
  • Fruitland, ID
  • NPI 1205466281
  Medicare reassignment Care Compare group NPD
• Jared M Scott, MD

  • Dermatology Physician
  • Boise, ID
  • NPI 1992808893
  Medicare reassignment Care Compare group NPD
• Logan Makayla Hawker, PA

  • Medical Physician Assistant
  • Boise, ID
  • NPI 1457133977
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1568112688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 NW 16TH ST.",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "83619",
            "telephone_number": "208-452-7450",
            "fax_number": "208-452-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 NW 16TH ST.",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "83619",
            "telephone_number": "208-452-7450",
            "fax_number": "208-452-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSC FRUITLAND",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDAHO SKIN SURGERY CENTER, PC",
        "enumeration_date": "2022-03-24",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "RAMOS",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-452-7450"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Idaho Orthotic Prosthetic Services, Inc
• Ikdo Fruitland LLC (Idaho Kids Dentistry & Orthodontics Fruitland)
• Anne Ingram, PA-C
• Brittney Irons, FNP
• Victor M Ishida, P.A.
• Iwasa Eye Center P.a.
• J Alan Timmons DDS PC
• Erin Doraine Jackson, PHARMD, CDM
• Sheila Diane Jacobs, MPT
• Mary Lynn James, PA

• Dermatology Physician in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.