KETCHUM FAMILY MEDICINE, PLLC - NPI 1720692650 - Family Medicine in Ketchum, ID

Q: What is Ketchum Family Medicine, PLLC's NPI number?

The NPI number for Ketchum Family Medicine, PLLC is 1720692650. It was assigned to this organization in the NPPES registry on September 8, 2020.

Q: What is Ketchum Family Medicine, PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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About Ketchum Family Medicine, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KETCHUM FAMILY MEDICINE, PLLC (NPI 1720692650) is a healthcare organization registered as a family medicine in Ketchum, Idaho and active in the NPI registry since September 2020. The organization holds a CLIA Waiver certificate valid through September 4, 2026 and lists Ashley Brown, Owner, as its authorized official.

NPPES Registry Identity

NPI1720692650

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameKETCHUM FAMILY MEDICINE, PLLC

Location Address431 WALNUT AVE NKetchum, ID 83340

Mailing AddressPo Box 6471Ketchum, ID 83340-6471 · (208) 622-3180

Phone(208) 622-3180

Organization SubpartNo

Authorized OfficialAshley BrownOwner · (208) 721-0676

Enumeration DateSeptember 8, 2020

Last NPPES UpdateNovember 12, 20202 updates tracked since enumeration

NPPES CertifiedNovember 12, 2020

✔ NPI 1720692650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

431 WALNUT AVE N, Ketchum, ID 83340

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 13D0960181

Ketchum Family Medicine · Ketchum, ID

Active · expires Sep 4, 2026

CLIA Number13D0960181

Laboratory TypePractitioner Other

Certificate Effective DateSeptember 5, 2024

Certificate Expiration DateSeptember 4, 2026

Laboratory DirectorAshley P. Brown Pa-C

Laboratory Phone(208) 622-3180

Laboratory LocationKetchum Family Medicine431 Walnut Ave N, Ketchum, ID 83340

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. KRISTEN PENDOLA ALLEN FNP

Nurse Practitioner (Family)

431 WALNUT AVE N
KETCHUM, ID 83340

Blaine County (208) 622-3180

ASHLEY BROWN PA-C

Physician Assistant (Medical)

431 WALNUT AVE N
KETCHUM, ID 83340

Blaine County (208) 622-3180

Frequently 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 Ketchum Family Medicine, PLLC's NPI number?

The NPI number for Ketchum Family Medicine, PLLC is 1720692650. It was assigned to this organization in the NPPES registry on September 8, 2020.

Where is Ketchum Family Medicine, PLLC located?

Ketchum Family Medicine, PLLC is located at 431 Walnut Ave N, Ketchum, ID 83340. The listed phone number is (208) 622-3180.

What is Ketchum Family Medicine, PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Ketchum Family Medicine, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D0960181) is associated with this NPI, valid through September 4, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ketchum Family Medicine, PLLC was last updated on November 12, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.