NPIMap

Organization Active NPI

State of Idaho Department of Health and Welfare

  • Psychiatric Hospital
  • Blackfoot, ID
National Provider Identifier
1992789101
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
#17 Issued in ID
Legal business name
STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Practice address
700 East Alice
Box 400
Blackfoot, ID 83221
Phone
(208) 785-1200
Fax
(208) 785-8518
NPI assigned
Dec 1, 2005
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Abbe Fisher
Title
Financial Specilist Sr
Phone
(208) 782-9938

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
State Hospital SouthCCN 134010
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110217000668 ID Part A Provider - Hospital 6002878527

Hospital certification: CCN 134010

Legal name
STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Doing business as
STATE HOSPITAL SOUTH
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Mar 22, 1994
Last certification
Jul 25, 2025
Beds
120
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
700 E Alice St
Blackfoot, ID 83221-4925
Other Hospital Practice Location
Hospital subgroups
Psychiatric

All disclosed owners & managing parties 4

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Abbe Fisher Individual W-2 Managing EmployeePatient Accounts Specialist Jul 5, 2016
Angela Loosli Individual W-2 Managing EmployeeFinancial Assistant Administrator Sep 25, 2005
James Patrick Price Individual Corporate DirectorHospital Administrator Jul 1, 2017
State of Idaho Department of Health and Welfare Organization, Blackfoot, ID Non-profit Other Jan 1, 1966

All facility ownership & control disclosures 2

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
State Hospital WestNampa, ID, CCN 134018 Hospital Other (100%) Jan 1, 2021
Syringa Chalet Nursing FacilityBlackfoot, ID, CCN 135111 Skilled nursing facility Operational/Managerial Control (100%) May 23, 2008

National Provider Directory

National Provider Directory
Tax ID family
Reg VI Mental Health Ctr114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X #17 ID Primary

Addresses

NPPES NPI Registry

Primary practice location

700 East Alice
Box 400
Blackfoot, ID 83221

Mailing address

700 E Alice St
PO Box 400
Blackfoot, ID 83221-4925
Phone (208) 785-1200

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
00844OtherIDBLUE CROSS OF IDAHO
002821500MedicaidID
20315OtherIDREGENCE BLUE SHIELD OF ID

Other names 1

NPPES NPI Registry
  • State Hospital South Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2026.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1992789101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E ALICE ST",
            "address_2": "PO BOX 400",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832214925",
            "telephone_number": "208-785-1200",
            "fax_number": "208-785-8518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 EAST ALICE",
            "address_2": "BOX 400",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "83221",
            "telephone_number": "208-785-1200",
            "fax_number": "208-785-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-01",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "ABBE",
        "authorized_official_title_or_position": "FINANCIAL SPECILIST SR",
        "authorized_official_telephone_number": "208-782-9938"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "ID",
            "license": "#17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "00844",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002821500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "20315",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Hospital South",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Blackfoot, ID

Sources for this page

Verify at the official NPI Registry.