FRUITLAND ORTHOPEDIC CLINIC
NPI 1710975057
Orthopaedic Surgery in Fruitland, ID

NPI Status: Active since October 11, 2005

Contact Information

1118 NW 16TH ST
SUITE C
FRUITLAND, ID
ZIP 83619
Phone: (208) 452-2510
Fax: (208) 452-2513

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  • Organization
  • Orthopaedic Surgery
  • CLIA Number: 13D2049635
  • CLIA Cert. Type: Ancillary Testing Site in Health Care Center
  • CLIA Exp. Date: 04-22-2027

About FRUITLAND ORTHOPEDIC CLINIC

This page provides the complete NPI Profile along with additional information for Fruitland Orthopedic Clinic, a provider established in Fruitland, Idaho operating as a Orthopaedic Surgery. The healthcare provider is registered in the NPI registry with number 1710975057 assigned on October 2005. The practitioner's primary taxonomy code is 207X00000X with license number M-6608 (ID). The provider is registered as an organization and their NPI record was last updated 5 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Jan Olof Dahlin M.d. (Owner)

NPI
1710975057
Provider Name
FRUITLAND ORTHOPEDIC CLINIC
Entity Type
Organization
Location Address
1118 NW 16TH ST SUITE C FRUITLAND, ID 83619
Location Phone
(208) 452-2510
Location Fax
(208) 452-2513
Mailing Address
1118 NW 16TH ST SUITE C FRUITLAND, ID 83619
Mailing Phone
(208) 452-2510
Mailing Fax
(208) 452-2513
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
10-11-2005
Last Update Date
08-22-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Orthopaedic Surgery

Taxonomy Code
207X00000X
Type
Allopathic & Osteopathic Physicians
License No.
M-6608
License State
ID
Taxonomy Description
An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207X00000XAllopathic & Osteopathic Physicians

Orthopaedic Surgery

MD13079 (OR)

Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

JAN OLOF DAHLIN M.D.

Authorized Official Title
OWNER
Authorized Official Phone
(208) 452-2510

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
266148MEDICAID (05)OR 

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
13D2049635
Facility Type
Ancillary Testing Site in Health Care Center
Certificate Effective Date
April 23, 2025
Certificate Expiration Date
April 22, 2027
Laboratory Director
ERIC RYSENGA
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Fruitland Orthopedic Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for FRUITLAND ORTHOPEDIC CLINIC

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1710975057
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
272018710010
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 2 + 0 + 1 + 8 + 7 + 1 + 0 + 0 + 1 + 0 + 24 = 53
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 53 = 77

The NPI number 1710975057 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1306834643 JAN OLOF DAHLIN M.D.
Individual
Orthopaedic Surgery1118 NW 16TH ST SUITE C
FRUITLAND, ID 83619
(208) 452-2510
1750372579DOMINICAN HEALTH SERVICES
Organization
Family Medicine1118 NW 16TH ST
FRUITLAND, ID 83619
(208) 452-6851
1447269691DR. RYAN CHARLES ZIMMERLY PHARM.D
Individual
Pharmacist1118 NW 16TH ST SUITE D.
FRUITLAND, ID 83619
(208) 452-8698
1558674663ST ALPHONSUS REGIONAL MEDICAL CENTER INC
Organization
Clinic/Center (Rural Health)1118 NW 16TH ST SUITE A
FRUITLAND, ID 83619
(208) 452-6851

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1710975057, enumerated in the NPI registry as an "organization" on October 11, 2005

The provider is located at 1118 Nw 16th St Suite C Fruitland, Id 83619 and the phone number is (208) 452-2510

This medical organization specializes in Orthopaedic Surgery with taxonomy code 207X00000X

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

The provider's CLIA number is 13D2049635 for a "ancillary testing site in health care center" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on October 11, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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