Meridian Advanced Psychiatry , LLC

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

Legal business name

MERIDIAN ADVANCED PSYCHIATRY , LLC

Practice address

1672 S Woodsage Ave.
Meridan, ID 83642

Phone

(208) 515-2273

Fax

(208) 515-2274

NPI assigned

Nov 25, 2019

Last updated

May 12, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Hulsey

Title

Ceo

Phone

(208) 789-0202

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Addi

  dba ADD Clinic of Idaho

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1326877762

  Member Of

  NPD member

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Addi

  dba ADD Clinic of Idaho

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1326877762
  NPPES parent name

Practitioners 46

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.

• Daniel Rulon Anderson, PMHNP-BC

  • Psychiatry Physician
  • Caldwell, ID
  • NPI 1790518751
  Medicare reassignment Care Compare group NPD
• Hayden Beard, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Rigby, ID
  • NPI 1609766401
  Medicare reassignment Care Compare group NPD
• Dean Bigelow, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Caldwell, ID
  • NPI 1245072594
  Medicare reassignment Care Compare group NPD
• Megan Lee Brock, PMNHP

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1083357651
  Medicare reassignment Care Compare group NPD
• Jamie Bumgardner, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Boise, ID
  • NPI 1679368658
  Medicare reassignment Care Compare group NPD
• Jeremiah Robins Clark, FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1356123657
  Medicare reassignment Care Compare group NPD
• Jarrod Vaughn Crump, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1184240194
  Medicare reassignment Care Compare group NPD
• Matthew Fowler, AGNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Nampa, ID
  • NPI 1053943688
  Medicare reassignment Care Compare group NPD
• Kennedy Nikell Friesen, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1437982329
  Medicare reassignment Care Compare group NPD
• Dianne Yvonne Head, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1235935222
  Medicare reassignment Care Compare group NPD
• Lenard L Malmin Jr., CNP

  • Nurse Practitioner
  • Nampa, ID
  • NPI 1255908489
  Medicare reassignment Care Compare group NPD
• Bradley Martin, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Twin Falls, ID
  • NPI 1114536737
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1609412683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1672 S WOODSAGE AVENUE",
            "address_2": "SUITE #120",
            "city": "MERIDAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-515-2273",
            "fax_number": "208-515-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1672 S WOODSAGE AVE.",
            "city": "MERIDAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-515-2273",
            "fax_number": "208-515-2274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1660 S Woodsage Ave",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836427670",
            "country_code": "US",
            "telephone_number": "208-515-2273",
            "fax_number": "208-515-2274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MERIDIAN ADVANCED PSYCHIATRY , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-25",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "HULSEY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-789-0202"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.