St Benedicts Family Medical Center

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

HH174 Issued in ID

Legal business name

ST BENEDICTS FAMILY MEDICAL CENTER

Practice address

414 N Lincoln
Suite 1
Jerome, ID 83338

Phone

(208) 324-0526

Fax

(208) 324-4809

NPI assigned

Oct 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Alan Stevenson

Title

Administrator

Phone

(208) 324-0425

Specialties & licenses 1

Addresses

Other identifiers 3

Member of 1

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

• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857

  Member Of

  NPD member

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992898605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 N LINCOLN",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "83338",
            "telephone_number": "208-324-4301",
            "fax_number": "208-324-3878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 N LINCOLN",
            "address_2": "SUITE 1",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "83338",
            "telephone_number": "208-324-0526",
            "fax_number": "208-324-4809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST BENEDICTS FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-324-0425",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ID",
            "license": "HH174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010033877",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00288500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "01701",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Evelyn Soares, CRC
• Southern Idaho Medicine PLLC
• Cory Joseph Sowards, MSW, LMSW
• St Benedicts Family Medical Center
• St Benedicts Family Medical Center (Fifth Avenue Clinic)
• St Benedicts FMC Physician Assistants
• St Luke's Magic Valley Regional Medical Center LTD (St Luke's Jerome)
• St Lukes Magic Valley Regional Medical Center LTD (St Lukes Jerome Swing Beds)
• St. Benedicts Family Medical Center
• Malorie Stoker

• Home Health Agency in Jerome, ID
• Providers in Jerome, ID by specialty
• Home Health Agency in Idaho

• 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.