MAGIC VALLEY MEDICINE PLLC NPI 1174939383

Nurse Practitioner (Family) in Twin Falls, ID

NPI 1174939383 Organization Nurse Practitioner Family Medicare Supplier Accepts Medicare Approved Payment CLIA Number 13D2204932 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

NPI Profile for MAGIC VALLEY MEDICINE PLLC

Magic Valley Medicine Pllc is a provider established in Twin Falls, Idaho specializing in nurse practitioner (family) . The NPI number of Magic Valley Medicine Pllc is 1174939383 and was assigned on July 2014. The practitioner's primary taxonomy code is 363LF0000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Samuel H Barker (Sole Member)

A nurse practitioner (NP) like Magic Valley Medicine Pllc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Magic Valley Medicine Pllc is a medicare supplier with PTAN 7369300001 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Traction Equipment or (TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies or Canes and/or Crutches or Orthoses: Off-The-Shelf.

The CLIA number of Magic Valley Medicine Pllc is 13D2204932 registered as a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to Magic Valley Medicine Pllc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1174939383

Provider NameMAGIC VALLEY MEDICINE PLLC
Provider Location Address844 WASHINGTON ST N STE 400 TWIN FALLS, ID 83301
Provider Mailing Address844 WASHINGTON ST N STE 400 TWIN FALLS, ID 83301
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date07-08-2014
Last Update Date07-11-2016


Primary Taxonomy

Taxonomy Code363LF0000X
ClassificationNurse Practitioner
TypePhysician Assistants & Advanced Practice Nursing Providers
SpecializationFamily

Business Address

MAGIC VALLEY MEDICINE PLLC
844 WASHINGTON ST N STE 400
TWIN FALLS, ID
ZIP 83301
Phone: (208) 734-0000
Fax: (208) 735-5053

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Mailing Address

MAGIC VALLEY MEDICINE PLLC
844 WASHINGTON ST N STE 400
TWIN FALLS, ID
ZIP 83301
Phone: (208) 734-0000
Fax: (208) 735-5053



Authorized Official

Authorized Official Name SAMUEL H BARKER
Authorized Official TitleSOLE MEMBER
Authorized Official Phone(208) 734-0000

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN7369300001
Accepts Medicare AssignmentYES
Provider Type ListNURSE PRACTITIONER.
Supplies List
  • Traction Equipment - Traction tables, Traction machines, Inversion tables
  • (TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies - Transcutaneous Electrical Nerve Stimulation (TENS) for the relief of acute post-operative pain
  • Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
  • Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
Competitive BiddingNO

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1174939383 is:

CLIA Number13D2204932
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1332B00000XSuppliersDurable Medical Equipment & Medical SuppliesNo

Taxonomy Description: a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
1174939383MEDICAID (05)ID
7369300001OTHER (01)MEDICARE DME
20005523MEDICARE PIN (08)

NPI Validation Check Digit Calculation


The following table explains step by step the NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1174939383
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2114418318316
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 4 + 4 + 1 + 8 + 3 + 1 + 8 + 3 + 1 + 6 + 24 = 67
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 67 = 33

The NPI number 1174939383 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1669787636 JILLIAN MARJORIE SIRUCEK ADEPOJU D.C.
Individual
Chiropractor844 WASHINGTON ST N STE 400
TWIN FALLS, ID 83301
(208) 736-8858
1831644608MAGIC VALLEY MEDICINE PLLC
Organization
Durable Medical Equipment & Medical Supplies844 WASHINGTON ST N STE 400
TWIN FALLS, ID 83301
(208) 734-0000
1043301682DR. SAMUEL HARRISON BARKER D.C., NP-C
Individual
Nurse Practitioner (Family)844 WASHINGTON ST N STE 400
TWIN FALLS, ID 83301
(208) 734-0000
1821603382QUICKER CARE PLLC
Organization
Clinic/Center (Urgent Care)844 WASHINGTON ST N STE 400
TWIN FALLS, ID 83301
(208) 734-0000

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Magic Valley Medicine Pllc is registered as an entity type code: 2. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.