NPIMap

Individual provider Active NPI

Michelle Marie Pehrson, FNP-C

  • Family Nurse Practitioner
  • Benton City, WA
National Provider Identifier
1619224896
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60513762 Issued in WA
Practice address
701 Dale Ave
Benton City, WA 99320-5250
Phone
(509) 588-4075
Fax
(509) 588-4197
NPI assigned
Aug 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-1194A ID
Family Nurse Practitioner 363LF0000X AP60513762 WA Primary

Addresses

Primary practice location

701 Dale Ave
Benton City, WA 99320-5250

Mailing address

723 Memorial Street
Prosser, WA 99350-1524
Phone (509) 786-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121127000633 ID Practitioner - Nurse Practitioner 8224289103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

465 McKenna Dr
Mountain Home, ID 83647-2143
Phone (208) 587-9703

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Family Medicine CurrentSince Oct 1, 2016 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Family Medicine CurrentSince Oct 1, 2016 Accepting new patients

Locations

1226 W River St
Boise, ID 83702
Phone (208) 331-1155

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

805 N 6th E
Mt Home, ID 83647
Phone (208) 587-2450

890 N 6th E
Mt Home, ID 83647
Phone (208) 376-3591

895 N 6th E
Mtn Home, ID 83647
Phone (208) 580-2661

465 McKenna Dr
Mtn Home, ID 83647
Phone (208) 587-9703

Interoperability endpoints

  • Direct secure messaging: mpehrson53412@direct.slhs.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419897600000",
    "number": "1619224896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 MEMORIAL STREET",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993501524",
            "telephone_number": "509-786-2222",
            "fax_number": "509-786-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DALE AVE",
            "city": "BENTON CITY",
            "state": "WA",
            "postal_code": "993205250",
            "telephone_number": "509-588-4075",
            "fax_number": "509-588-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEHRSON",
        "first_name": "MICHELLE",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2014-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1194A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60513762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton City, WA

Sources for this page

Verify at the official NPI Registry.