NPIMap

Organization Active NPI

St. Joseph Regional Medical Center

  • Emergency Medicine Physician
  • Lewiston, ID
National Provider Identifier
1790816262
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ST. JOSEPH REGIONAL MEDICAL CENTER
Practice address
415 6TH St
Lewiston, ID 83501-2431
Phone
(208) 743-2511
Fax
(208) 799-5554
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Authorized official

Name
Susan Colburn
Title
Director of Business Services
Phone
(208) 799-5200

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X ID
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X ID Primary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X ID
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X ID
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X ID
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X ID
Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364S00000X ID

Addresses

Primary practice location

415 6TH St
Lewiston, ID 83501-2431

Mailing address

415 6TH St
Lewiston, ID 83501-2431
Phone (208) 743-2511

Other identifiers 8

IdentifierTypeStateIssuer
000010005407OtherIDREGENCE OF IDAHO
000010005405OtherIDREGENCE OF IDAHO
8K552OtherIDBLUE CROSS OF IDAHO
000010005404OtherIDREGENCE OF IDAHO
7045891MedicaidWA
7046543MedicaidWA
8C576OtherIDBLUE CROSS OF IDAHO
7046279MedicaidWA

Other names 1

  • ST. JOSEPH REGIONAL MEDICAL CENTER PHYSICIANS Other name

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1790816262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-743-2511",
            "fax_number": "208-799-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-743-2511",
            "fax_number": "208-799-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "COLBURN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS SERVICES",
        "authorized_official_telephone_number": "208-799-5200"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": "ID",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OF IDAHO",
            "identifier": "000010005407",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OF IDAHO",
            "identifier": "000010005405",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "8K552",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OF IDAHO",
            "identifier": "000010005404",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7045891",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7046543",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "8C576",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7046279",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. JOSEPH REGIONAL MEDICAL CENTER PHYSICIANS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; 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.