NPIMap

Organization Active NPI

Indigo Idaho Services, LLC

  • Family Medicine Physician
  • Coeur d'Alene, ID
National Provider Identifier
1821799263
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INDIGO IDAHO SERVICES, LLC
Practice address
2836 N Ramsey Rd
Coeur D Alene, ID 83815-9002
Phone
(208) 482-3400
NPI assigned
Mar 13, 2023
Last updated
Mar 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Authorized official

Name
William Robertson
Title
President
Phone
(253) 403-1272

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2836 N Ramsey Rd
Coeur D Alene, ID 83815-9002

Mailing address

P.O. Box 5299
Ms: 820-5-Pco
Tacoma, WA 98415-0299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230630002272 ID Part B Supplier - Clinic/Group Practice 1850750373 Receives reassigned benefits from 24 practitioners
Practice locations: Coeur D Alene, ID

National Provider Directory

National Provider Directory

Member of 2

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

Locations

2836 N Ramsey Rd
Coeur D Alene, ID 83815
Phone (208) 482-3400

3155 Duportail St
#B
Richland, WA 99352

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1821799263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5299",
            "address_2": "MS: 820-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2836 N RAMSEY RD",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159002",
            "telephone_number": "208-482-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO IDAHO SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-403-1272"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.