NPIMap

Organization Active NPI

Idaho State University

  • Primary Care Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1962095711
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
IDAHO STATE UNIVERSITY
Practice address
1311 E Central Dr
Meridian, ID 83642-7991
Phone
(208) 373-1734
Fax
(833) 499-1813
NPI assigned
Feb 12, 2021
Last updated
Aug 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary

Addresses

Primary practice location

1311 E Central Dr
Meridian, ID 83642-7991

Mailing address

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

Other names 1

  • ISU Meridian Healthcare Other name

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
This NPI is an additional NPI on the enrollment
Practice locations: Pocatello, ID; Salmon, ID; Meridian, ID

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

Locations

1311 E Central Dr
Rm 556
Meridian, ID 83642

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1962095711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 E CENTRAL DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427991",
            "telephone_number": "208-373-1734",
            "fax_number": "833-499-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 E CENTRAL DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427991",
            "telephone_number": "208-373-1734",
            "fax_number": "833-499-1813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CLINICS DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "208-373-1743"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISU Meridian Healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 27, 2021; 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.