NPIMap

Individual provider Active NPI

Lore Beth Wootton, M.D.

  • Family Medicine Physician
  • Weiser, ID
National Provider Identifier
1649365404
Registry record updated Jul 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-7162 Issued in ID
Practice address
683 E 3Rd St
Weiser, ID 83672-2248
Phone
(208) 549-0211
Fax
(208) 549-0104
NPI assigned
Oct 4, 2006
Last updated
Jul 15, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-7162 ID Primary

Addresses

Primary practice location

683 E 3Rd St
Weiser, ID 83672-2248

Mailing address

PO Box 871
Weiser, ID 83672-0871
Phone (208) 549-0211

Other identifiers 1

IdentifierTypeStateIssuer
804102100MedicaidID

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
I20100708000900 ID Practitioner - Family Practice 6608863832 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Maryland School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Two Rivers Medical Clinic, PAGroup PAC ID 8628065950, 3 clinicians

Practice addresses (Care Compare)

683 E 3Rd St
Weiser, ID 83672-2248
Phone (208) 549-0211

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-7162IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Two Rivers Medical Clinic, PA Family Medicine CurrentSince Jan 13, 1997 Accepting new patients

Locations

683 E 3rd St
Weiser, ID 83672
Phone (208) 549-0211

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Two Rivers Medical Clinic, PAWeiser, ID, CCN 133836 Rural health clinic 5% Or Greater Direct Ownership Interest Mar 1, 1998

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1649365404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 871",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836720871",
            "telephone_number": "208-549-0211",
            "fax_number": "208-549-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 E 3RD ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722248",
            "telephone_number": "208-549-0211",
            "fax_number": "208-549-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOTTON",
        "first_name": "LORE",
        "middle_name": "BETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-7162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804102100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weiser, ID

Sources for this page

Verify at the official NPI Registry.