NPIMap

Organization Active NPI

Human Supports of Idaho

  • General Practice Physician
  • Caldwell, ID
National Provider Identifier
1700129491
Registry record updated Dec 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
HUMAN SUPPORTS OF IDAHO
Practice address
206 E Elm St
Caldwell, ID 83605-4815
Phone
(208) 454-8389
Fax
(208) 454-8404
NPI assigned
Apr 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2025

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

Authorized official

Name
Alita Ruby
Title
Administrative Service Manager
Phone
(208) 454-8389

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

206 E Elm St
Caldwell, ID 83605-4815

Mailing address

4477 W Emerald St Ste C100
Boise, ID 83706-2058
Phone (208) 321-0160

Other practice location 1

4477 W Emerald St Ste C100
Boise, ID 83706-2058
Phone (208) 321-0160

Other identifiers 1

IdentifierTypeStateIssuer
20002419OtherIDMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130305000118 ID Part B Supplier - Clinic/Group Practice 0244485894 Receives reassigned benefits from 10 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID; Caldwell, ID; Orofino, ID

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

314 Badiola St
Caldwell, ID 83605
Phone (208) 454-8389

2200 N Ironwood Pl
Coeur D Alene, ID 83814
Phone (208) 667-6486

108 E Owyhee Ave
Homedale, ID 83628

Practitioners & affiliated clinicians

Practitioners 10

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": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766448000000",
    "number": "1700129491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4477 W EMERALD ST STE C100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062058",
            "telephone_number": "208-321-0160",
            "fax_number": "208-321-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 E ELM ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054815",
            "telephone_number": "208-454-8389",
            "fax_number": "208-454-8404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4477 W Emerald St Ste C100",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837062058",
            "country_code": "US",
            "telephone_number": "208-321-0160",
            "fax_number": "208-321-0221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HUMAN SUPPORTS OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A",
        "authorized_official_last_name": "RUBY",
        "authorized_official_first_name": "ALITA",
        "authorized_official_title_or_position": "ADMINISTRATIVE SERVICE MANAGER",
        "authorized_official_telephone_number": "208-454-8389"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "20002419",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2025; 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.