St Benedicts Family Medical Center

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ST BENEDICTS FAMILY MEDICAL CENTER

Practice address

115 5TH Ave W
Jerome, ID 83338-1824

Phone

(208) 324-8831

Fax

(208) 324-6678

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Warren Alan Stevenson

Title

Ceo

Phone

(208) 324-1122

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• FIFTH AVENUE CLINIC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric S Cassidy, MD

  • Emergency Medicine Physician
  • Twin Falls, ID
  • NPI 1982647830
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1922037530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 5TH AVE W",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833381824",
            "telephone_number": "208-324-8831",
            "fax_number": "208-324-6678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 5TH AVE W",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833381824",
            "telephone_number": "208-324-8831",
            "fax_number": "208-324-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST BENEDICTS FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-324-1122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807893400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002287100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "8A489",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010006293",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FIFTH AVENUE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Justin G Smith, MD
• Diana Evelyn Soares, CRC
• Southern Idaho Medicine PLLC
• Cory Joseph Sowards, MSW, LMSW
• St Benedicts Family Medical Center
• St Benedicts Family Medical Center
• St Benedicts FMC Physician Assistants
• St Luke'S Magic Valley Regional Medical Center LTD
• St Lukes Magic Valley Regional Medical Center LTD
• St. Benedicts Family Medical Center

• Multi-Specialty Clinic/Center in Jerome, ID
• Providers in Jerome, ID by specialty
• Multi-Specialty Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.