STATE HOSPITAL SOUTH MEDICAL CLINIC
NPI 1538225545
Clinic/Center in Blackfoot, ID
About State Hospital South Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
STATE HOSPITAL SOUTH MEDICAL CLINIC (NPI 1538225545) is a healthcare organization registered as a clinic/center in Blackfoot, Idaho and active in the NPI registry since December 2006. The organization lists Lynn D Shields, Patient Accounts Specialist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 5
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
State Hospital South Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to State Hospital South Medical Clinic, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 13D0520437
State Hospital South · Blackfoot, IDFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is State Of Idaho Department Of Health And Welfare's NPI number?
The NPI number for State Of Idaho Department Of Health And Welfare is 1538225545. It was assigned to this organization in the NPPES registry on December 28, 2006. The provider is doing business as State Hospital South Medical Clinic.
Where is State Of Idaho Department Of Health And Welfare located?
State Of Idaho Department Of Health And Welfare is located at 700 E. Alice Box 400, Blackfoot, ID 83221. The listed phone number is (208) 785-1200.
What is State Of Idaho Department Of Health And Welfare's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is State Of Idaho Department Of Health And Welfare enrolled in Medicare?
Yes. State Of Idaho Department Of Health And Welfare is registered in the Medicare PECOS enrollment system.
When is State Of Idaho Department Of Health And Welfare's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Idaho, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through State Of Idaho Department Of Health And Welfare?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to State Of Idaho Department Of Health And Welfare, in Family Practice and Internal Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for State Of Idaho Department Of Health And Welfare was last updated on July 15, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# State Hospital South Medical Clinic · NPI 1538225545
Clinic/Center organization in Blackfoot, Idaho. Organization record, active in the CMS NPPES registry since December 28, 2006.
## Identity
- **NPI:** 1538225545 (Entity type: Organization)
- **Enumerated:** December 28, 2006
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Legal business name:** State Of Idaho Department Of Health And Welfare
- **Organization subpart:** Yes (part of State Hospital South)
- **Authorized official:** Lynn Shields, PATIENT ACCOUNTS SPECIALIST
## Practice location
- **Address:** 700 E. ALICE, BOX 400, Blackfoot, ID 83221-0400
- **Phone:** (208) 785-1200 · **Fax:** (208) 785-8518
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Idaho, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Internal Medicine (1); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 15, 2016
- **Other identifiers:** Medicaid 002823200 (ID); Medicare OSCAR/certification 1373057 (ID); Medicare PIN 20002136; and 2 more
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1538225545) · Data from the CMS NPPES public registry.