Kent Leroy Hamilton, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

RPA-149 Issued in ID

Practice address

683 E 3Rd St
Weiser, ID 83672-2248

Phone

(208) 549-0211

Fax

(208) 549-0104

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Two Rivers Medical Clinic, PA

  • Rural Health Clinic/Center
  • Weiser, ID
  • NPI 1376662486
  Medicare reassignment

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228694400000",
    "number": "1821183617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 871",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836720871",
            "telephone_number": "208-549-0211",
            "fax_number": "208-549-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 E 3RD ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722248",
            "telephone_number": "208-549-0211",
            "fax_number": "208-549-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMILTON",
        "first_name": "KENT",
        "middle_name": "LEROY",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "RPA-149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004369700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anika Garcia
• Alicia Gonzalez
• Michelle Lynn Grendahl, LPC
• Janice Elaine Grimaldo, SLP
• Tom Gudmestad, DDS
• Melissa A Hathhorn, NP
• Laura Haun, A.T.C.
• Duane Ray Hess, DC
• Craig Philip Hessing, DPT
• Gary L. Hoopes, P.T.

• Physician Assistant in Weiser, ID
• Providers in Weiser, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.