Active NPI
David L. Budge, PA
- Physician Assistant
- Hailey, ID
National Provider Identifier
1588754162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-1611
- Practice address
- 507 S Main St
Hailey, ID 83333-8929 - Phone
- (208) 542-9111
- Fax
- (208) 542-9114
- NPI assigned
- Oct 13, 2006
- Last updated
- Jun 16, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 330483-1206 | UT | |
| Physician Assistant | 363A00000X | PA-1611 | ID | Primary |
Addresses
Primary practice location
507 S Main St
Hailey, ID 83333-8929
Mailing address
740 S Woodruff Ave
Idaho Falls, ID 83401-5285
Phone (208) 542-9111
Other practice location 1
50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-7715
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA-1611 | Other | ID | STATE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1611 | ID | MD | Physician Assistant |
| 330483-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Utah Emergency Physicians | Past | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients | |
| University of Utah Emergency Physicians | Past | Accepting new patients |
Interoperability endpoints
- david.budge.1@15123.direct.athenahealth.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
-
- Emergency Medical Services (Emergency Medicine) Physician
- Salt Lake City, UT
- NPI 1093769218
-
dba Memorial Hosptial of Sweetwater County
- Emergency Medicine Physician
- Rock Springs, WY
- NPI 1730583295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592265600000",
"number": "1588754162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "740 S WOODRUFF AVE",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834015285",
"telephone_number": "208-542-9111",
"fax_number": "208-542-9114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 S MAIN ST",
"city": "HAILEY",
"state": "ID",
"postal_code": "833338929",
"telephone_number": "208-542-9111",
"fax_number": "208-542-9114"
}
],
"practiceLocations": [
{
"address_1": "50 N Medical Dr",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "841320001",
"country_code": "US",
"telephone_number": "801-581-7715",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUDGE",
"first_name": "DAVID",
"middle_name": "L.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2020-06-16",
"certification_date": "2020-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "330483-1206",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-1611",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "PA-1611",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Hailey, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.