NPIMap

Organization Active NPI

Southwest District Health

  • Public Health or Welfare Agency
  • Caldwell, ID
National Provider Identifier
1598748337
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
SOUTHWEST DISTRICT HEALTH
Practice address
13307 Miami LN
Caldwell, ID 83607-4701
Phone
(208) 455-5305
Fax
(208) 455-5368
NPI assigned
Nov 25, 2005
Last updated
Feb 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Authorized official

Name
Kelly S Boster
Title
Office Specialist II
Phone
(208) 455-5348

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

13307 Miami LN
Caldwell, ID 83607-4701

Mailing address

13307 Miami LN
Caldwell, ID 83607-4701
Phone (208) 455-5305

Other identifiers 4

IdentifierTypeStateIssuer
002824100MedicaidHI
002828400MedicaidID
002821600MedicaidID
805201700MedicaidID

Other names 1

  • State of Idaho Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040724000290 ID Part B Supplier - Clinic/Group Practice 4789663220 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID
O20130403000376 ID Part B Supplier - Clinic/Group Practice 0143465666 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Caldwell, ID; Emmett, ID; Payette, ID; Weiser, ID
O20190508001819 ID MDPP Supplier - in-Person MDPP Supplier 0143465666 Practice locations: Emmett, ID; Weiser, ID; Payette, ID; Homedale, ID; Caldwell, ID

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Southwest District Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

120 S Cole Rd
Ste 120
Boise, ID 83709
Phone (208) 334-3220

13301 Miami LN
Caldwell, ID 83607

13307 Miami Ln
Caldwell, ID 83607
Phone (208) 455-5300

1008 E Locust St
Emmett, ID 83617
Phone (208) 365-6371

1155 3rd Ave N
Payette, ID 83661
Phone (208) 642-9321

46 W Court St
Weiser, ID 83672
Phone (208) 549-2370

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20689/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1598748337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13307 MIAMI LN",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836074701",
            "telephone_number": "208-455-5305",
            "fax_number": "208-455-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13307 MIAMI LN",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836074701",
            "telephone_number": "208-455-5305",
            "fax_number": "208-455-5368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DISTRICT HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-25",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "BOSTER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE SPECIALIST II",
        "authorized_official_telephone_number": "208-455-5348"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002824100",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002828400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002821600",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805201700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State of Idaho",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.