Edith Mary Roe, NP-BC
Individual provider Active NPI Adult Health Nurse Practitioner · Homedale, ID
NPI 1831667468 · NPPES record last updated Apr 21, 2020
Key facts
- NPI
- 1831667468
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 60044 (ID)
- Practice address
- 126 W Idaho Ave
Homedale, ID 83628-0037 - Phone
- (208) 337-7038
- NPI assigned
- Nov 13, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID, OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241010000953 | ID | Practitioner - Nurse Practitioner | 4385788108 | Reassigns benefits to 1 organization |
| I20241010002328 | OR | Practitioner - Nurse Practitioner | 4385788108 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201910193NP | OR | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roe & Roe Inc | Current |
Accepting new patients | |
| Signify Health, LLC | Nurse Practitioner | Current |
Accepting new patients |
| Roe and Roe, Inc. | Current | Accepting new patients | |
| Signify Health Medical Associates, PLLC | Nurse Practitioner | Current |
Accepting new patients |
| Idaho Street Medical Clinic | Current |
Accepting new patients | |
| Idaho Street Medical Clinic | Past |
Accepting new patients |
Locations
950 W Bannock St
Ste 1100
Boise, ID 83702
Phone (201) 293-7689
126 W Idaho Ave
Homedale, ID 83628
Phone (208) 337-7038
780 Commercial St SE
Ste 100
Salem, OR 97301
Phone (469) 466-7037
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 201910193NP | OR | |
| Adult Health Nurse Practitioner | 363LA2200X | 60044 | ID | Yes |
Addresses
Primary practice location
126 W Idaho Ave
Homedale, ID 83628-0037
Mailing address
126 W. Idaho Ave
Homedale, ID 83628
Phone (208) 337-7038
Other practice location 1
24900 Market Rd
Parma, ID 83660
Phone (208) 859-4103
Other providers in Homedale, ID
- Perkins & Associates PA
- James Edward Perkins Jr.
- Elizabeth Pike
- Roe & Roe Inc
- Roe and Roe, Inc.
- Charlotte Tomevi
- Janet Woodburn
- Z-Inc
All providers in Homedale, ID · Adult Health Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.