NPIMap

Organization Active NPI

Pioneer Family Medicine PLLC

  • Family Medicine Physician
  • Meridian, ID
National Provider Identifier
1952335929
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-253 Issued in ID
Legal business name
PIONEER FAMILY MEDICINE PLLC
Practice address
4740 N. Penngrove Way
Ste. 100
Meridian, ID 83646
Phone
(208) 938-3663
Fax
(208) 938-3664
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Authorized official

Name
Jason Scott Ludwig, DONPI 1144258534
Title
Owner
Phone
(208) 938-3663

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X O-253 ID Primary

Addresses

Primary practice location

4740 N. Penngrove Way
Ste. 100
Meridian, ID 83646

Mailing address

4740 N. Penngrove Way
Ste. 100
Meridian, ID 83646
Phone (208) 938-3663

Other identifiers 1

IdentifierTypeStateIssuer
806456700MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090710000464 ID Part B Supplier - Clinic/Group Practice 5193877850 Receives reassigned benefits from 13 practitioners
Practice locations: Meridian, ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D1003406Pioneer Family Medicine4740 N Penngrove Way Ste 100, Meridian, ID 83646Certificate of waiverNov 1, 2026

National Provider Directory

National Provider Directory

Locations

4740 N Penngrove Way
Ste 100
Meridian, ID 83646
Phone (208) 938-3663

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBBGCA

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566518400000",
    "number": "1952335929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N. PENNGROVE WAY",
            "address_2": "STE. 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-938-3663",
            "fax_number": "208-938-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N. PENNGROVE WAY",
            "address_2": "STE. 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-938-3663",
            "fax_number": "208-938-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2019-08-23",
        "status": "A",
        "authorized_official_last_name": "LUDWIG",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-938-3663",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806456700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.