Individual provider Active NPI

Amy Pabawena, NP

  • Family Nurse Practitioner
  • Pocatello, ID
National Provider Identifier
1821545211
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-54117 Issued in ID
Practice address
500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880
Phone
(208) 232-7862
Fax
(208) 232-7869
NPI assigned
Sep 2, 2016
Last updated
Sep 5, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-54117 ID Primary

Addresses

Primary practice location

500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880

Mailing address

500 S 11TH Ave
Ste 400
Pocatello, ID 83201-4835
Phone (208) 232-7862

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170123000442 ID Practitioner - Nurse Practitioner 1355623661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franklin County Medical CenterGroup PAC ID 8820909104, 25 clinicians

Practice addresses (Care Compare)

44 N 1St
Preston, ID 83263-1326
Phone (208) 852-0137

64 N 1St
Preston, ID 83263-1326
Phone (208) 852-3662

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-54117IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Franklin County Medical Center CurrentSince Apr 10, 2022 Accepting new patients
Franklin County Medical Center CurrentSince Apr 10, 2022 Accepting new patients
Franklin County Medical Center Past Accepting new patients

Locations

64 N 1st E
Ste 100
Preston, ID 83263
Phone (208) 852-0137

47 N 1st E
Preston, ID 83263
Phone (208) 852-2900

44 N 1st E
Preston, ID 83263
Phone (208) 852-0137

Interoperability endpoints

  • Direct secure messaging: amy.pabawena.1@17373.direct.athenahealth.com

Organizations & group practices 3

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 1

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": "1472774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1821545211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE",
            "address_2": "STE 400",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014835",
            "telephone_number": "208-232-7862",
            "fax_number": "208-232-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE STE 400",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014880",
            "telephone_number": "208-232-7862",
            "fax_number": "208-232-7869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PABAWENA",
        "first_name": "AMY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-02",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-54117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.