Family Health Services Corporation

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FAMILY HEALTH SERVICES CORPORATION

Doing business as

Family Health Services

Practice address

218 W Nez Perce
Jerome, ID 83338-5077

Phone

(208) 324-3471

Fax

(208) 324-9191

NPI assigned

May 25, 2006

Last updated

Apr 12, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Aaron Houston

Title

Cio

Phone

(208) 734-3312

Specialties & licenses 11

Addresses

Other identifiers 1

Other names 1

• FAMILY HEALTH SERVICES Doing business as

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730135310. Details of each certification follow.

• CCN 131818 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 131818

Legal name

FAMILY HEALTH SERVICES CORPORATION

Doing business as

FAMILY HEALTH SERVICES

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 6, 1999

Last certification

Apr 6, 1999

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Feb 22, 1982 in ID

Enrollment address

218 W Nez Perce
Jerome, ID 83338-5077

Other NPIs on the same Medicare enrollment 35

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

• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Buhl, ID
  • NPI 1003862525

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Burley, ID
  • NPI 1033165550

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Jerome, ID
  • NPI 1073188728

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Rupert, ID
  • NPI 1093761694

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1124571815

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Kimberly, ID
  • NPI 1154089795

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1194341388

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1235279217

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Bellevue, ID
  • NPI 1245804400

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1255028221

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Declo, ID
  • NPI 1285297804

  O20040216000531

  Same enrollment
• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1306462593

  O20040216000531

  Same enrollment

Locations

All disclosed owners & managing parties 6

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

All facility ownership & control disclosures 21

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Practitioners 53

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.

• Dawn Ariel Jennings, MD

  • Family Medicine Physician
  • Rupert, ID
  • NPI 1437350774
  NPD
• Basil Clarence Anderson, M.D.

  • Family Medicine Physician
  • Kimberly, ID
  • NPI 1518282110
  NPD (past)
• Jesse J Balls, PA-C

  • Medical Physician Assistant
  • Jerome, ID
  • NPI 1487026191
  NPD (past)
• Jameson Bastow, DO

  • Family Medicine Physician
  • Jerome, ID
  • NPI 1639791361
  NPD (past)
• Tabatha Jo Baumgartner, LCSW

  • Clinical Social Worker
  • Rupert, ID
  • NPI 1225569338
  NPD (past)
• Nicolas A Bregante, PA-C

  • Medical Physician Assistant
  • Buhl, ID
  • NPI 1538485180
  NPD (past)
• Rebecca Cabello

  • Family Nurse Practitioner
  • Twin Falls, ID
  • NPI 1437921830
  NPD (past)
• Cathy White Canty, M.D.

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1013974658
  NPD (past)
• Allison Cluff, PA-C

  • Physician Assistant
  • Burley, ID
  • NPI 1922615848
  NPD (past)
• Keith E Davis, M.D.

  • Family Medicine Physician
  • Shoshone, ID
  • NPI 1043277635
  NPD (past)
• Matthew David Detemple, D.O.

  • Family Medicine Physician
  • Burley, ID
  • NPI 1467419150
  NPD (past)
• Matthew Duersch, M.D.

  • Family Medicine Physician
  • Jerome, ID
  • NPI 1902941750
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1730135310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016856",
            "telephone_number": "208-734-3312",
            "fax_number": "208-734-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 W NEZ PERCE",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833385077",
            "telephone_number": "208-324-3471",
            "fax_number": "208-324-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A",
        "authorized_official_last_name": "HOUSTON",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "CIO",
        "authorized_official_telephone_number": "208-734-3312",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "ID",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002547005",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Family Care Physicians, PA
• Family Health Services Corporation
• Family Health Services Corporation (Family Health Services)
• Family Health Services Corporation
• Family Health Services Corporation (Family Health Services - Diabetic Education)
• Family Health Services Pharmacy
• Anna Fox, MD
• Anne B Fullmer, FNP
• Kellsy Teresa Gallup, M.S., LPC
• Alexandria M Gandiaga

• Federally Qualified Health Center (FQHC) in Jerome, ID
• Providers in Jerome, ID by specialty
• Federally Qualified Health Center (FQHC) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.