CHILDRENS KIDNEY SPECIALISTS PLLC (NPI# 1700088002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700088002 |
| Entity Type | Organization |
| Organization Name | CHILDRENS KIDNEY SPECIALISTS PLLC |
| Practice Address |
100 E Idaho St 200 Boise ID 83712-6223 |
| Mailing Address |
1935 Nw Norfolk Ct Portland OR 97229-8448 |
| Practice Telephone | 2083817336 |
| Practice Fax Number | 2083817495 |
| Mailing Telephone | 5032973178 |
| Mailing Fax Number | 2083817495 |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2012-06-20 |
| Authorized Official Name | DR. RANDALL JENKINS (DOCTOR) |
| Authorized Official Telephone | 2083817336 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0210X |
Pediatrics Specialization: Pediatric Nephrology |
M6943 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 003401500 | 05 | |
| ID | BLUE SHIELD | 000010026970 | 01 |
| Street Address |
100 E IDAHO ST 200 |
| City | BOISE |
| State | ID |
| Zip Code | 83712-6223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336133776 | Gregory G Janos | Pediatrics | 100 E Idaho St, Suite 200, Boise, ID 83712-6267 | 2005-08-31 |
| 1205444734 | Allison Reed | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2020-07-21 |
| 1619585247 | Christina Gullion | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2020-07-20 |
| 1548897556 | Brooke Hueftle | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2020-03-27 |
| 1194364919 | Sarah Rosemarie Hogue | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2019-12-26 |
| 1710525167 | Leslie Lynn Lamontagne | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2019-12-17 |
| 1487292843 | Lauren Zupsic | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2019-12-17 |
| 1659919199 | Stephanie Matta | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2019-12-16 |
| 1104464627 | David Blair Wilson | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2019-12-16 |
| 1386282788 | Jessie Modlin | Pharmacist | 100 E Idaho St, Boise, ID 83712-6267 | 2019-12-16 |
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|---|---|---|---|---|
| 1477016012 | Veranda At Barber Station LLC | Assisted Living Facility | 3266 E. Barber Valley Drive, Boise, ID 83712 | 2019-04-10 |
| 1891258612 | Mary Elizabeth Riedel | Occupational Therapist | 190 E Bancock St., Boise, ID 83712 | 2019-04-09 |
| 1427523968 | Q17 Health Partners LLC | Surgery | 100 East Idaho Street #317, Boise, ID 83712 | 2018-10-11 |
| 1053898247 | Travis Dale Worwood | Social Worker | South Entrance, 1075 E. Park Blvd, Boise, ID 83712 | 2018-07-20 |
| 1689166761 | Kristen Nicole Ray | Social Worker | 109 E Bannock St, Boise, ID 83712 | 2018-06-04 |
| 1740706894 | Meghan Heitstuman | Social Worker | 190 E Bannock Street, Boise, ID 83712 | 2017-08-21 |
| 1942759725 | Kay Craig | Physical Therapist | 190 Bannock, Boise, ID 83712 | 2016-09-22 |
| 1235686395 | Sharon Bjornson | Physical Therapist | 190 East Bannack, Boise, ID 83712 | 2016-09-07 |
| 1033576491 | Heather Hussey | Genetic Counselor, MS | 100 E Idaho Street, Msti Genetics, Boise, ID 83712 | 2016-01-15 |
| 1295139137 | Amie Bartholomeus | Massage Therapist | 100 East Idaho Street, St Luke's Mountain States Tumor Institute, Boise, ID 83712 | 2014-10-21 |
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| Taxonomy Code | 2080P0210X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Nephrology |
| A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension and renal replacement therapy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316981632 | Jean U Bender | Pediatrics | 305 E Jefferson St, Boise, ID 83712-6273 | 2006-06-16 |
| 1619934213 | Randall D. Jenkins | Pediatrics | 100 E Idaho St, Suite 304, Boise, ID 83712 | 2006-04-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.