NPIMap

Individual provider Active NPI

Cheyenne Koble

  • Physician Assistant
  • Plymouth, NH
National Provider Identifier
1750069241
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
101 Boulder Point Dr Ste 1
Plymouth, NH 03264-3170
Phone
(603) 536-4000
NPI assigned
Jul 6, 2023
Last updated
Apr 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

101 Boulder Point Dr Ste 1
Plymouth, NH 03264-3170

Mailing address

1260 Elm St
Manchester, NH 03101-1305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240430000714 NH Practitioner - Physician Assistant 9830539493 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-State Health CenterGroup PAC ID 1951363563, 32 clinicians

Practice addresses (Care Compare)

100 Robie Rd
Alexandria, NH 03222-6063
Phone 60374462001004

101 Boulder Point Dr
Plymouth, NH 03264-3170
Phone 60353640001004

6 S Mountain Dr
Lincoln, NH 03251
Phone 60353640001004

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-State Health Center CurrentSince Apr 1, 2024 Accepting new patients

Locations

101 Boulder Point Dr
Ste 1
Plymouth, NH 03264
Phone (603) 238-3537

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1688601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1750069241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 ELM ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BOULDER POINT DR STE 1",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032643170",
            "telephone_number": "603-536-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBLE",
        "first_name": "CHEYENNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-06",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, NH

Sources for this page

Verify at the official NPI Registry.