PURE HEALTHCARE OF IDAHO LLC – Multi-Specialty Clinic/Center, NPI 1568005809
Multi-Specialty Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for PURE HEALTHCARE OF IDAHO LLC
4179 S RIVERBOAT RD STE 220
TAYLORSVILLE, UT 841232986
Phone: (801) 755-3387
Type: Mailing
West Emerald Street, Boise, Ada County, Idaho, 83704, United States
BOISE, ID 837048781
Phone: (855) 550-3358
Type: Location
222 S MAIN ST STE 500
SALT LAKE CITY, UT 841012275
Phone:
Type: Mailing
1411 Falls Ave E Ste 1151A
Twin Falls, ID 833013455
Phone: (208) 543-7995
Type: Location
1750 W McMillan Rd Ste 120
Meridian, ID 836466891
Phone: (208) 900-4480
Fax: (801) 327-0211
Type: Location
11118 Moss Ln
Nampa, ID 836518015
Phone: (208) 563-5910
Fax: (801) 327-0211
Type: Location
916 W Ironwood Dr Ste Ul1
Coeur D Alene, ID 838142642
Phone: (208) 577-5380
Fax: (801) 327-0211
Type: Location
3423 Merlin Dr
Idaho Falls, ID 834047430
Phone: (208) 217-9099
Fax: (801) 327-0211
Type: Location
5975 W OVERLAND RD
BOISE, ID 837093012
Phone: (208) 488-4998
Fax: (801) 327-0211
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-04-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-06-30 (20 days away).
Enrollment records
1
Earliest due date
2026-06-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20200427001080 | O | Clinic/Group Practice | ID | 2026-06-30 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84123)
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Reviews
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