Ann Pendleton Beach, MD
Individual provider Active NPI Family Medicine Physician · Boise, ID
NPI 1912968892 · NPPES record last updated Feb 1, 2011
Key facts
- NPI
- 1912968892
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M7794 (ID)
- Practice address
- 777 N Raymond St
Boise, ID 83704-9251 - Phone
- (208) 514-2500
- Fax
- (208) 322-7018
- NPI assigned
- Mar 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 8
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Geisel School of Medicine at Dartmouth, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Full Circle Health Inc
Practice addresses (Care Compare)
2275 S Eagle Rd
Suite 120
Meridian, ID 83642-2620
Phone (208) 514-2520
Hospital & facility affiliations
- Saint Alphonsus Regional Medical Center
- St Luke'S Regional Medical Center
- St Luke'S Nampa Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Full Circle Health |
Federally qualified health center | Corporate Director | Jun 27, 2022 |
| Full Circle Health |
Federally qualified health center | Corporate Director | Jun 27, 2022 |
| Full Circle Health |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Jun 27, 2022 May 16, 2016 |
| Full Circle Health |
Federally qualified health center | W-2 Managing Employee | May 16, 2016 |
| Full Circle Health |
Federally qualified health center | Corporate Director | Jun 27, 2022 |
| Full Circle Health |
Federally qualified health center | Corporate Director | Jul 1, 2022 |
| Full Circle Health |
Federally qualified health center | W-2 Managing Employee | May 16, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031215000176 | ID | Practitioner - Family Practice | 5092612523 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M7794 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Full Circle Health, Inc. | Current |
Accepting new patients |
Locations
777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030
325 W Idaho St
Boise, ID 83702
Phone (208) 514-2525
2275 S Eagle Rd
Ste 120
Meridian, ID 83642
Phone (208) 514-2520
Interoperability endpoints
- abeach1563126@direct.trinity-health.org
- abeach294816@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M7794 | ID | Yes |
Addresses
Primary practice location
777 N Raymond St
Boise, ID 83704-9251
Mailing address
777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11029901 | Other | ID | MEDICARE PTAN |
| 805202000 | Medicaid | ID | |
| P00031256 | Other | RAILROAD MEDICARE | |
| 1102998 | Other | CIGNA MEDICARE | |
| 1102990 | Other | CIGNA MEDICARE |
Other providers in Boise, ID
- Malinda S Baze
- Rachael Bazzett
- Jacqueline Bazzle
- BCS PA
- Floyd Bea
- Cory Beach
- Kelly Beach
- Peighton Beach
- Beacon Pain Clinic
- Patricia Ann Beal
All providers in Boise, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2011. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.