NPIMap

Organization Active NPI

St Benedicts FMC Physician Assistants

  • Physician Assistant
  • Jerome, ID
National Provider Identifier
1700053774
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
08 Issued in ID
Legal business name
ST BENEDICTS FMC PHYSICIAN ASSISTANTS
Practice address
709 N Lincoln Ave
Jerome, ID 83338-1851
Phone
(208) 324-4301
Fax
(208) 324-9529
NPI assigned
May 9, 2008
Last updated
May 9, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ST BENEDICTS FAMILY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2008

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

Authorized official

Name
Alan Stevenson
Title
Administrator
Phone
(208) 324-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 08 ID Primary

Addresses

Primary practice location

709 N Lincoln Ave
Jerome, ID 83338-1851

Mailing address

709 N Lincoln Ave
Jerome, ID 83338-1851
Phone (208) 324-4301

National Provider Directory

National Provider Directory
Tax ID family
St Benedicts Hosp2 organizations share this tax ID, including this one
Part of
St Benedicts Hosp

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1700053774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 N LINCOLN AVE",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833381851",
            "telephone_number": "208-324-4301",
            "fax_number": "208-324-9529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 N LINCOLN AVE",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833381851",
            "telephone_number": "208-324-4301",
            "fax_number": "208-324-9529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST BENEDICTS FMC PHYSICIAN ASSISTANTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST BENEDICTS FAMILY MEDICAL CENTER",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-324-1122"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "08",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jerome, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.