NPIMap

Organization Active NPI

Community Care Rexburg LLC

  • Clinic/Center
  • Rexburg, ID
National Provider Identifier
1740554237
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
W 110632 Issued in ID
Legal business name
COMMUNITY CARE REXBURG LLC
Practice address
72 E Main St
Rexburg, ID 83440-1926
Phone
(208) 525-8448
Fax
(208) 524-2749
NPI assigned
Feb 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Authorized official

Name
Evelyn Rossi, VICE PRESIDENT
Title
Patient Financial Services
Phone
(208) 557-2716

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X W 110632 ID Primary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

72 E Main St
Rexburg, ID 83440-1926

Mailing address

72 E Main St
Rexburg, ID 83440-1926
Phone (208) 525-8448

National Provider Directory

National Provider Directory

Locations

1425 Parkway Dr
Blackfoot, ID 83221
Phone (208) 785-2600

Practitioners & affiliated clinicians

Practitioners 12

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": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1740554237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401926",
            "telephone_number": "208-525-8448",
            "fax_number": "208-524-2749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401926",
            "telephone_number": "208-525-8448",
            "fax_number": "208-524-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE REXBURG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "ROSSI",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "208-557-2716",
        "authorized_official_credential": "VICE PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ID",
            "license": "W 110632",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.