NPIMap

Organization Active NPI

R Bret Campbell DO & Assoc LLC

  • Family Medicine Physician
  • Burley, ID
National Provider Identifier
1952744641
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
R BRET CAMPBELL DO & ASSOC LLC
Practice address
1501 Hiland Ave Ste a
Burley, ID 83318-2688
Phone
(208) 878-9432
Fax
(208) 878-4576
NPI assigned
Apr 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
R Bret Campbell, D.O.
Title
Doctor of Osteopathy
Phone
(208) 878-9432

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1501 Hiland Ave Ste a
Burley, ID 83318-2688

Mailing address

1404 Pomerelle Ave
Suite B
Burley, ID 83318-2688
Phone (208) 878-9432

Other identifiers 1

IdentifierTypeStateIssuer
1124041116MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160405000354 ID Part B Supplier - Clinic/Group Practice 2860799905 Receives reassigned benefits from 3 practitioners
Practice locations: Burley, ID

National Provider Directory

National Provider Directory

Locations

1501 Hiland Ave
Ste A
Burley, ID 83318
Phone (208) 878-9432

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1952744641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 POMERELLE AVE",
            "address_2": "SUITE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182688",
            "telephone_number": "208-878-9432",
            "fax_number": "208-878-4576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 HILAND AVE STE A",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182688",
            "telephone_number": "208-878-9432",
            "fax_number": "208-878-4576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R BRET CAMPBELL DO & ASSOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "BRET",
        "authorized_official_title_or_position": "DOCTOR OF OSTEOPATHY",
        "authorized_official_telephone_number": "208-878-9432",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124041116",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.