Jordan Ridge Family Medicine LLC

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

Legal business name

JORDAN RIDGE FAMILY MEDICINE LLC

Doing business as

Mobile Unit-Idaho

Practice address

322 E Front St
Boise, ID 83702-7374

Phone

(385) 274-3959

Fax

(385) 274-3970

NPI assigned

Jan 10, 2023

Organization subpart

No

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

Authorized official

Name

Emily Castillo, MANAGER

Title

Manager

Phone

(702) 480-2550

Specialties & licenses 1

Addresses

Other names 1

• Mobile Unit-Idaho Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Jordan Ridge Family Medicine LLC

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1770509754

  8820091473

  Same PAC ID

Practitioners 5

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

• Jeffrey L. Thompson, PA-C

  • Physician Assistant
  • Ammon, ID
  • NPI 1902917966
  Medicare reassignment NPD
• Karen Bohn, PA-C

  • Physician Assistant
  • West Valley City, UT
  • NPI 1528533775

  ID

  Medicare reassignment NPD
• Diane M. Kendall, APRN, BC

  • Nurse Practitioner
  • Sandy, UT
  • NPI 1659397545

  ID

  Medicare reassignment NPD
• Tara Lee Reese, PA-C

  • Physician Assistant
  • Baker City, OR
  • NPI 1518449560

  ID

  Medicare reassignment NPD
• Natalie Angelica Solis, APRN

  • Nurse Practitioner
  • Ogden, UT
  • NPI 1053953778
  Medicare reassignment NPD

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

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1578277950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-480-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 E FRONT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027374",
            "telephone_number": "385-274-3959",
            "fax_number": "385-274-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN RIDGE FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-480-2550",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Unit-Idaho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen Donald Jones, MD
• Susan S Jones, SLP
• Tami Sue Jones, LCSW
• Wesley Jones, DO
• Carter Jons
• Andrew Jordan
• Anthony Scott Jordan, MD
• Julie Jordan, OT
• Kassidi Renee Jordan, LMSW
• Lauren Jordan, LCSW

• Mobile Radiology Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Mobile Radiology Clinic/Center in Idaho

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