NPIMap

Organization Active NPI

Sterling Provider Group

  • Rural Health Clinic/Center
  • Burley, ID
National Provider Identifier
1659915593
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STERLING PROVIDER GROUP
Practice address
1404 Pomerelle Ave Ste A1
Burley, ID 83318-2013
Phone
(208) 878-8783
Fax
(208) 878-8786
NPI assigned
Nov 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Authorized official

Name
Corbin Bunnage, PA-CNPI 1447325485
Title
Provider/Owner
Phone
(208) 542-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary
Urgent Care Clinic/Center 261QU0200X
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

1404 Pomerelle Ave Ste A1
Burley, ID 83318-2013

Mailing address

740 S Woodruff Ave
Idaho Falls, ID 83401-5285
Phone (208) 542-9111

Other practice location 1

1404 Pomerelle Ave Ste A1
Burley, ID 83318-2013
Phone (208) 878-8783

Other identifiers 1

IdentifierTypeStateIssuer
13D2099992OtherIDCLIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240913003642 ID Part A Provider - Rural Health Clinic 2264773373 Practice locations: Burley, ID

Rural health clinic certification: CCN 133867

Legal name
STERLING PROVIDER GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 3, 2025
Last certification
Feb 3, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Jan 4, 2019 in ID
Enrollment address
1404 Pomerelle Ave
Ste A1
Burley, ID 83318-2013

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Sterling Provider Group19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Matthew F Harris Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 9%
Adam T Garfield Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 5%
Operational/Managerial ControlChief of Staff Jan 1, 2023 100%
Corbin Bunnage Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 21%
Devon E Dahlke Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 21%
Jacob D Anderson Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 5%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 52

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

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781654400000",
    "number": "1659915593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015285",
            "telephone_number": "208-542-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 POMERELLE AVE STE A1",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182013",
            "telephone_number": "208-878-8783",
            "fax_number": "208-878-8786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1404 Pomerelle Ave Ste A1",
            "address_purpose": "LOCATION",
            "city": "Burley",
            "state": "ID",
            "postal_code": "833182013",
            "country_code": "US",
            "telephone_number": "208-878-8783",
            "fax_number": "208-878-8786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STERLING PROVIDER GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-04",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A",
        "authorized_official_last_name": "BUNNAGE",
        "authorized_official_first_name": "CORBIN",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "208-542-9111",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "13D2099992",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

Verify at the official NPI Registry.