NPIMap

Organization Active NPI

North Canyon Mountain Home Clinic

  • Clinic/Center
  • Mountain Home, ID
National Provider Identifier
1649759374
Registry record updated Aug 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NORTH CANYON MOUNTAIN HOME CLINIC
Practice address
840 N 4TH E
Mountain Home, ID 83647-2166
Phone
(208) 934-8829
Fax
(208) 934-4874
NPI assigned
Aug 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

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

Authorized official

Name
Tim Powers
Title
Ceo
Phone
(208) 934-8765

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X ID Primary

Addresses

Primary practice location

840 N 4TH E
Mountain Home, ID 83647-2166

Mailing address

267 N Canyon Dr
Gooding, ID 83330-5500
Phone (208) 934-4433

Other identifiers 1

IdentifierTypeStateIssuer
1184932584MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090409000304 ID Part B Supplier - Clinic/Group Practice 0941371439 Receives reassigned benefits from 203 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Twin Falls, ID; Mountain Home, ID; Hailey, ID; Jerome, ID; Buhl, ID; Gooding, ID

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Partners in Healthcare Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1649759374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 N CANYON DR",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833305500",
            "telephone_number": "208-934-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N 4TH E",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836472166",
            "telephone_number": "208-934-8829",
            "fax_number": "208-934-4874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CANYON MOUNTAIN HOME CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-934-8765"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184932584",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.