NPIMap

Organization Active NPI

Nobility Behavioral Health LLC

Doing business as Nobility Better Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Pocatello, ID
National Provider Identifier
1720722549
Registry record updated Apr 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
NOBILITY BEHAVIORAL HEALTH LLC
Doing business as
Nobility Better Health
Practice address
415 N 3Rd Ave Ste B
Pocatello, ID 83201-6306
Phone
(208) 646-4165
Fax
(208) 646-4195
NPI assigned
Apr 27, 2022
Last updated
Apr 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2023

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

Authorized official

Name
Mr. Robert Ted Allen
Title
Ceo
Phone
(208) 317-3353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

415 N 3Rd Ave Ste B
Pocatello, ID 83201-6306

Mailing address

9075 Stoney Creek Rd
Pocatello, ID 83204-7242
Phone (208) 317-3353

Other names 1

  • Nobility Better Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221012003995 ID Part B Supplier - Clinic/Group Practice 6800262015 Receives reassigned benefits from 5 practitioners
Practice locations: Pocatello, ID

National Provider Directory

National Provider Directory

Locations

414 N 3 Ave Ste B
Pocatello, ID 83201

415 N 3rd Ave
#B
Pocatello, ID 83201
Phone (208) 646-4165

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1720722549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9075 STONEY CREEK RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832047242",
            "telephone_number": "208-317-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N 3RD AVE STE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016306",
            "telephone_number": "208-646-4165",
            "fax_number": "208-646-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOBILITY BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2023-04-17",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "TED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-317-3353",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nobility Better Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nobility Better Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.