| Pearl Health Clinic | |
|
2705 E 17th St Ammon ID 83406-6601 | |
| (208) 346-7500 | |
| (208) 346-7501 |
| Full Name | Pearl Health Clinic |
|---|---|
| Speciality | Counselor |
| Location | 2705 E 17th St, Ammon, Idaho |
| Authorized Official Name and Position | Jennifer Brink (BILLING AND CREDENTIALING MANAGER) |
| Authorized Official Contact | 2083467500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pearl Health Clinic 2705 E 17th St Ammon ID 83406-6601 Ph: (208) 346-7500 | Pearl Health Clinic 2705 E 17th St Ammon ID 83406-6601 Ph: (208) 346-7500 |
| NPI Number | 1447426465 |
|---|---|
| Provider Enumeration Date | 04/30/2008 |
| Last Update Date | 07/26/2024 |
| Certification Date | 07/26/2024 |
| Medicare PECOS PAC ID | 0840356077 |
|---|---|
| Medicare Enrollment ID | O20090312000617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447426465 | NPI | - | NPPES |
| 1447426465 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rosemary H Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972504231 PECOS PAC ID: 2668495029 Enrollment ID: I20060111000830 |
| Provider Name | Stephen Denagy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336273085 PECOS PAC ID: 5294891438 Enrollment ID: I20090312000669 |
| Provider Name | Manuel A Sierra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861467375 PECOS PAC ID: 1759330343 Enrollment ID: I20090610000683 |
| Provider Name | Daniel H Mcgrath |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083953871 PECOS PAC ID: 7810137387 Enrollment ID: I20130703000397 |
| Provider Name | Jason T Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639507551 PECOS PAC ID: 5092943456 Enrollment ID: I20140109000672 |
| Provider Name | Brian P Beesley |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1205129897 PECOS PAC ID: 1658523287 Enrollment ID: I20140923001377 |
| Provider Name | Frances C Acoba |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093907883 PECOS PAC ID: 8527384189 Enrollment ID: I20150226001471 |
| Provider Name | Briana Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467887992 PECOS PAC ID: 5799093936 Enrollment ID: I20151007002495 |
| Provider Name | Michelle Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386010833 PECOS PAC ID: 8921317868 Enrollment ID: I20151016000073 |
| Provider Name | Cristina Sanchez Jaquez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447448659 PECOS PAC ID: 4385807759 Enrollment ID: I20160212001703 |
| Provider Name | Anna B Giemza-palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427415553 PECOS PAC ID: 6103125968 Enrollment ID: I20160428001372 |
| Provider Name | Adam L Nickell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497164347 PECOS PAC ID: 1153607858 Enrollment ID: I20170412001177 |
| Provider Name | John W Collins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992937874 PECOS PAC ID: 0244501773 Enrollment ID: I20170802001416 |
| Provider Name | Dean Woodrow Shandy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356786198 PECOS PAC ID: 2163704990 Enrollment ID: I20200916002445 |
| Provider Name | Jayde Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023618659 PECOS PAC ID: 1456764117 Enrollment ID: I20210119002691 |
| Provider Name | Steven Esplin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801488044 PECOS PAC ID: 8820497720 Enrollment ID: I20210526001007 |
| Provider Name | Tiffany Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184153504 PECOS PAC ID: 3476953282 Enrollment ID: I20210616001716 |
| Provider Name | Katrina Forsmann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255792743 PECOS PAC ID: 0749685600 Enrollment ID: I20210816003950 |
| Provider Name | Lael Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689332769 PECOS PAC ID: 6204221955 Enrollment ID: I20220317000962 |
| Provider Name | Nicole Boyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275266991 PECOS PAC ID: 4587030549 Enrollment ID: I20221014002919 |
| Provider Name | Benjamin Pixton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780312272 PECOS PAC ID: 7012383953 Enrollment ID: I20221018003547 |
| Provider Name | Christian Schmutz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023645272 PECOS PAC ID: 1951706076 Enrollment ID: I20230328001458 |
| Provider Name | Andria Lea Dotson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588365647 PECOS PAC ID: 5991164154 Enrollment ID: I20230706000789 |
| Provider Name | Christopher James Jankowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265114516 PECOS PAC ID: 7618321696 Enrollment ID: I20230925002100 |
| Provider Name | Sara Larsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609551720 PECOS PAC ID: 9032564158 Enrollment ID: I20231010002238 |
| Provider Name | Kathleen Victoria Poduska |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770009854 PECOS PAC ID: 3779933775 Enrollment ID: I20240102003953 |
| Provider Name | Jaxson Layne Stark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144559527 PECOS PAC ID: 6204287162 Enrollment ID: I20240104004885 |
| Provider Name | Shayla Renee Hickman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225515299 PECOS PAC ID: 3971956079 Enrollment ID: I20240124004929 |
| Provider Name | Doug Hulett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467562603 PECOS PAC ID: 7810330891 Enrollment ID: I20240206004454 |
| Provider Name | Brianne Scott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265035836 PECOS PAC ID: 1557704400 Enrollment ID: I20240207002152 |
| Provider Name | Zakery R Warren |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053597344 PECOS PAC ID: 2466725536 Enrollment ID: I20240209000829 |
| Provider Name | Michelle Marchant |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760982854 PECOS PAC ID: 7810330594 Enrollment ID: I20240209001035 |
| Provider Name | Jennifer Dee Kerner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144315722 PECOS PAC ID: 0244674059 Enrollment ID: I20240220004334 |
| Provider Name | Krystalrose Worthington |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750687992 PECOS PAC ID: 4385089648 Enrollment ID: I20240227002464 |
| Provider Name | Bonita Joy Avery |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780941278 PECOS PAC ID: 3971948092 Enrollment ID: I20240228004241 |
| Provider Name | Colin Waters |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104279413 PECOS PAC ID: 5698111995 Enrollment ID: I20240308002440 |
| Provider Name | Shawn Lapray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609197383 PECOS PAC ID: 8123468469 Enrollment ID: I20240502003589 |
| Provider Name | Quinn Blake Thibodeau |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619102183 PECOS PAC ID: 6002358371 Enrollment ID: I20240603002485 |
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