SHH Medical Group Idaho, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SHH MEDICAL GROUP IDAHO, LLC

Practice address

3751 N Cloverdale Rd
Boise, ID 83713-3610

Phone

(208) 321-5073

Fax

(208) 376-0269

NPI assigned

Jul 3, 2019

Organization subpart

No

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

Authorized official

Name

Jason Fletcher

Title

President

Phone

(208) 376-7298

Specialties & licenses 1

Addresses

Other names 1

• AUTUMN RIDGE MEDICAL GROUP Doing business as

Locations

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562112000000",
    "number": "1972165579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1176",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836801176",
            "telephone_number": "208-376-7298",
            "fax_number": "208-377-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3751 N CLOVERDALE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837133610",
            "telephone_number": "208-321-5073",
            "fax_number": "208-376-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHH MEDICAL GROUP IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-03",
        "last_updated": "2019-07-03",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-376-7298"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AUTUMN RIDGE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barry G. Sherwood, D.C.
• Charles T Sherwood, PA-C
• Michael Joseph Shevlin, MD
• Sarah K Shewayish, MD
• Douglas J Shey, LPC
• Xiaoming Shi, MD
• Katrina Shibambo
• Joshua Shieh
• Ali Shields, LCSW
• Michaela Shields, PSYD

• Primary Care Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Primary Care Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.