NPIMap

Organization Active NPI

Idaho State University

Doing business as Idaho State University Speech & Hearing Clinic

  • Audiologist
  • Pocatello, ID
National Provider Identifier
1952474777
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
IDAHO STATE UNIVERSITY
Doing business as
Idaho State University Speech & Hearing Clinic
Practice address
650 Memorial Drive
BLDG #68
Pocatello, ID 83201
Phone
(208) 282-3495
Fax
(208) 282-4571
NPI assigned
Nov 17, 2006
Last updated
Feb 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Cynthia L Rock
Title
Clinics Director of Operations
Phone
(208) 373-1743

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

650 Memorial Drive
BLDG #68
Pocatello, ID 83201

Mailing address

921 S 8TH Ave Stop 8116
Pocatello, ID 83209-0002
Phone (208) 282-3495

Other practice location 1

1311 E Central Dr
Meridian, ID 83642-7991
Phone (208) 373-1734

Other practice location 2

805 Main St
Salmon, ID 83467-4316
Phone (208) 282-3495

Other names 1

  • Idaho State University Speech & Hearing Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060412000292 ID Part B Supplier - Clinic/Group Practice 4688683030 Receives reassigned benefits from 39 practitioners
4 other NPIs on this enrollment
Practice locations: Pocatello, ID; Salmon, ID; Meridian, ID

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Idaho State University22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

1311 E Central Dr
Rm 532H
Meridian, ID 83642

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1952474777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S 8TH AVE STOP 8116",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090002",
            "telephone_number": "208-282-3495",
            "fax_number": "208-282-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 MEMORIAL DRIVE",
            "address_2": "BLDG #68",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-282-3495",
            "fax_number": "208-282-4571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 E Central Dr",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836427991",
            "country_code": "US",
            "telephone_number": "208-373-1734",
            "fax_number": "833-499-1813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "805 Main St",
            "address_purpose": "LOCATION",
            "city": "Salmon",
            "state": "ID",
            "postal_code": "834674316",
            "country_code": "US",
            "telephone_number": "208-282-3495",
            "fax_number": "833-499-1813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IDAHO STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINICS DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "208-373-1743"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho State University Speech & Hearing Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.