NPIMap

Organization Active NPI

St Lukes Clinic - Wood River LLC

  • Internal Medicine Physician
  • Ketchum, ID
National Provider Identifier
1972891604
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
62 Issued in ID
Legal business name
ST LUKES CLINIC - WOOD RIVER LLC
Practice address
100 Hospital Drive
Ketchum, ID 83340-9999
Phone
(208) 727-8100
NPI assigned
Jul 15, 2011
Last updated
Apr 23, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ST LUKES MEDICAL CENTER WOODRIVER LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Kathryn Fowler
Title
Senior VP, Cfo
Phone
(208) 381-8717

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 62 ID
Emergency Medicine Physician 207P00000X 62 ID
Family Medicine Physician 207Q00000X 62 ID
Internal Medicine Physician 207R00000X 62 ID Primary
Obstetrics & Gynecology Physician 207V00000X 62 ID
Orthopaedic Surgery Physician 207X00000X 62 ID
Urology Physician 208800000X 62 ID

Addresses

Primary practice location

100 Hospital Drive
Ketchum, ID 83340-9999

Mailing address

PO Box 640
Boise, ID 83701-0640
Phone (208) 381-2222

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120404000474 ID Part B Supplier - Clinic/Group Practice 3173783818 Receives reassigned benefits from 83 practitioners
Practice locations: Hailey, ID; Ketchum, ID

National Provider Directory

National Provider Directory
Part of
St Lukes Medical Ctr Wo

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1450 Aviation Dr
Ste 201
Hailey, ID 83333
Phone (208) 720-8311

1450 Aviation Dr
Ste 203
Hailey, ID 83333
Phone (208) 727-8295

1000 State St
McCall, ID 83638
Phone (208) 634-2221

775 Pole Line Rd W
Ste 112
Twin Falls, ID 83301
Phone (208) 814-1000

Practitioners & affiliated clinicians

Practitioners 113

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 113

NPI Registry JSON

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1972891604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837010640",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DRIVE",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833409999",
            "telephone_number": "208-727-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES CLINIC - WOOD RIVER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKES MEDICAL CENTER WOODRIVER LTD",
        "enumeration_date": "2011-07-15",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "SENIOR VP, CFO",
        "authorized_official_telephone_number": "208-381-8717"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "62",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "62",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "62",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "62",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "62",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "62",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "62",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ketchum, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; 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.