NPIMap

Organization Active NPI

Physicians Clinic PLLC

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1992895866
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICIANS CLINIC PLLC
Practice address
4902 W State St
Boise, ID 83703-3326
Phone
(208) 853-3100
Fax
(208) 853-3120
NPI assigned
Oct 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Corinne K Chastain
Title
Office Manager
Phone
(208) 375-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4902 W State St
Boise, ID 83703-3326

Mailing address

4902 W State St
Boise, ID 83703-3326
Phone (208) 853-3100

Other identifiers 1

IdentifierTypeStateIssuer
8M400OtherIDBLUE CROSS

Other names 1

  • STATE STREET IMMEDIATE MEDICAL CARE Other name

National Provider Directory

National Provider Directory
Tax ID family
McMillan Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992895866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4902 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033326",
            "telephone_number": "208-853-3100",
            "fax_number": "208-853-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4902 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033326",
            "telephone_number": "208-853-3100",
            "fax_number": "208-853-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN",
        "authorized_official_first_name": "CORINNE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-375-0500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8M400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STATE STREET IMMEDIATE MEDICAL CARE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.