I Care Medical Clinic PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 519 Issued in ID

Legal business name

I CARE MEDICAL CLINIC PA

Practice address

430 N Bridge St
Saint Anthony, ID 83445-1425

Phone

(208) 624-4402

Fax

(208) 624-4409

NPI assigned

Oct 18, 2012

Last updated

Apr 4, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Rickell Willmore, MPAS, PAC

Title

Owner

Phone

(208) 624-4402

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Stephen J. Cheyne, M.D.

  • General Practice Physician
  • Saint Anthony, ID
  • NPI 1346391513
  NPD (past)

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1952654741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 N BRIDGE ST",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834451425",
            "telephone_number": "208-624-4402",
            "fax_number": "208-624-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N BRIDGE ST",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834451425",
            "telephone_number": "208-624-4402",
            "fax_number": "208-624-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I CARE MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "WILLMORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "RICKELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-624-4402",
        "authorized_official_credential": "MPAS, PAC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA 519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807122700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amberly Guymon, LMSW
• Mary Christine Harvey, LM, CPM
• Huntco Inc. (Falls Drug and Hardware)
• James K Hunter
• William J. Hunter, RPH
• Neil L Kunz, D.M.D.
• Gabriel Aaron Lenz, DMD
• Katie M McFarland, LCSW
• Whittney Kay Miller, FNP-C
• Jacob Wayne Moss, M.D., J.D.

• Physician Assistant in Saint Anthony, ID
• Providers in Saint Anthony, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; 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.