ADVANCED INTEGRATED MEDICAL CENTER (NPI# 1033674916) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033674916 |
| Entity Type | Organization |
| Organization Name | ADVANCED INTEGRATED MEDICAL CENTER |
| Practice Address |
1395 Nw Main St Blackfoot ID 83221-3936 |
| Mailing Address |
1742 N 500 W Apt 102 Logan UT 84341-2875 |
| Practice Telephone | 2087850270 |
| Practice Fax Number | 2087850683 |
| Mailing Telephone | 4357641775 |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2020-06-18 |
| Authorized Official Name | DEE STEVENS (OWNER/OPERATOR) |
| Authorized Official Telephone | 4357641775 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PERSONAL NPI | 1962456681 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1598 Delphic Way Ste A2, Pocatello, ID 832012200 | 2082320220 |
| Street Address |
1395 NW MAIN ST |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-3936 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720521719 | Advanced Chiropractic of Blackfoot | Preferred Provider Organization | 1395 Nw Main St, Blackfoot, ID 83221-3936 | 2016-11-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134508443 | Mh Health Care Services, PC | Nurse Practitioner | 415 W Collins Rd, C/o Baf Employee Health Center, Blackfoot, ID 83221-5642 | 2015-05-20 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1255567210 | Hyrum Davenport | Nurse Practitioner | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2009-06-04 |
| 1285661033 | Douglas Gilbert | Nurse Practitioner | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2006-06-27 |
| 1881620730 | Guss Grimmett | Nurse Practitioner | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039988 | Seth Thomas Six | Nurse Practitioner | 803 Mill Rd, Lewiston, ID 83501-0745 | 2020-09-25 |
| 1255947255 | Brandon Smith | Nurse Practitioner | 5067 Camden St, Chubbuck, ID 83202-3501 | 2020-09-16 |
| 1407469166 | Mmg LLC | Nurse Practitioner | 80 Cottonwood Ct Ste 150, Eagle, ID 83616-6577 | 2020-08-24 |
| 1588288336 | Katina Ross | Nurse Practitioner | 11695 W Baserri Dr, Boise, ID 83709-1307 | 2020-06-07 |
| 1164043162 | Slavik Osipchuk | Nurse Practitioner | 2329 W Root Creek St, Meridian, ID 83646-4678 | 2020-04-30 |
| 1538708862 | Kay Dawn Martens | Nurse Practitioner | 334 E 200 S, Burley, ID 83318-5433 | 2020-01-03 |
| 1760025639 | Kimberly Watson | Nurse Practitioner | 3536 W Moon Lake St, Meridian, ID 83646-8304 | 2019-10-23 |
| 1932741212 | Kylie B Di Lulo | Nurse Practitioner | 1309 E Fall Ct, Boise, ID 83706-5076 | 2019-10-08 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1649824277 | Bryana Michel Hinck | Nurse Practitioner | 150 W Broderick Dr, Meridian, ID 83646-0009 | 2019-07-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.