KETCHUM FAMILY MEDICINE, PLLC
NPI 1720692650
Family Medicine in Ketchum, ID
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, 2028 and lists Ashley Brown, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ketchum Family Medicine, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Ketchum Family Medicine, PLLC, which bills Medicare for the services they deliver. 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 13D0960181
Ketchum Family Medicine · Ketchum, 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 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.
Is Ketchum Family Medicine, PLLC enrolled in Medicare?
Yes. Ketchum Family Medicine, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ketchum Family Medicine, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to Ketchum Family Medicine, PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, 2028. 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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Ketchum Family Medicine, Pllc · NPI 1720692650
Family Medicine organization in Ketchum, Idaho. Organization record, active in the CMS NPPES registry since September 8, 2020.
## Identity
- **NPI:** 1720692650 (Entity type: Organization)
- **Enumerated:** September 8, 2020
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Ashley Brown, OWNER
## Practice location
- **Address:** 431 WALNUT AVE N, Ketchum, ID 83340
- **Phone:** (208) 622-3180
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Family Practice) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 12, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1720692650) · Data from the CMS NPPES public registry.