ELMER G DODGE JR. (NPI# 1508918236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508918236 |
| Entity Type | Individual |
| Full Name | ELMER G DODGE JR. |
| Credential | FNP |
| Practice Address |
9858 W State St Star ID 83669-5210 |
| Mailing Address |
Po Box 44267 Boise ID 83711-0267 |
| Practice Telephone | 2082860666 |
| Practice Fax Number | 2082860565 |
| Mailing Telephone | 2082860666 |
| Mailing Fax Number | 2082860565 |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WG0000X |
Registered Nurse Specialization: General Practice |
NP534A | ID | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | NP-534A | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 806045400 | 05 | |
| ID | BLUE CROSS OF IDAHO | NPQP7 | 01 |
| ID | REGENCE BLUE SHIELD OF ID | 000010150031 | 01 |
| Street Address |
9858 W STATE ST |
| City | STAR |
| State | ID |
| Zip Code | 83669-5210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578062048 | Sherry Lynn Stanton | Nurse Practitioner | 9858 W State St, Star, ID 83669-5210 | 2018-02-09 |
| 1447702683 | Beverlee K Furner, Np Pllc | Nurse Practitioner | 9858 W State St, Star, ID 83669-5210 | 2016-11-03 |
| 1508918244 | Star Medical Center PC | Registered Nurse | 9858 W State St, Star, ID 83669-5210 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861999377 | Bi-mart Corporation | Pharmacy | 11347 W State Street, Star, ID 83669 | 2018-04-11 |
| 1285014779 | Boise River Physical Therapy | Physical Therapist | 64 S Star Road, Suite 2, Star, ID 83669 | 2015-06-01 |
| 1003250754 | Carol Tidwell | Counselor | 11104 W State St, Star, ID 83669 | 2013-04-24 |
| 1780816652 | Mark Olsen | Dentist | 12192 Evely Pines Ln, Star, ID 83669 | 2009-08-11 |
| 1770759912 | Richard E. Adams | Chiropractor | 11231 W Hercules Dr A, Star, ID 83669 | 2008-05-07 |
| 1861674707 | Keen Eye Vision Pllc | Optometrist | 170 South Seneca Springs Way, Suite 100, Star, ID 83669 | 2007-12-03 |
| 1639358773 | Natural Smile Dental Pllc | Dentist | 10706 W State St, Suite 105, Star, ID 83669 | 2007-10-25 |
| 1659566727 | Allied Mental Health Services, P.l.l.c. | Case Management | 11104 W. State St., Star, ID 83669 | 2007-09-11 |
| 1972709103 | Martin A Mangan | Family Medicine | 10717 W State Street, Star, ID 83669 | 2007-06-25 |
| 1699021246 | Leslie Leet | Social Worker | 246 N Main St, Star, ID 83669 | 2012-08-01 |
| Find all providers in zip 83669 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039988 | Seth Thomas Six | Nurse Practitioner | 803 Mill Rd, Lewiston, ID 83501-0745 | 2020-09-25 |
| 1255947255 | Brandon Smith | Nurse Practitioner | 5067 Camden St, Chubbuck, ID 83202-3501 | 2020-09-16 |
| 1407469166 | Mmg LLC | Nurse Practitioner | 80 Cottonwood Ct Ste 150, Eagle, ID 83616-6577 | 2020-08-24 |
| 1588288336 | Katina Ross | Nurse Practitioner | 11695 W Baserri Dr, Boise, ID 83709-1307 | 2020-06-07 |
| 1164043162 | Slavik Osipchuk | Nurse Practitioner | 2329 W Root Creek St, Meridian, ID 83646-4678 | 2020-04-30 |
| 1538708862 | Kay Dawn Martens | Nurse Practitioner | 334 E 200 S, Burley, ID 83318-5433 | 2020-01-03 |
| 1760025639 | Kimberly Watson | Nurse Practitioner | 3536 W Moon Lake St, Meridian, ID 83646-8304 | 2019-10-23 |
| 1932741212 | Kylie B Di Lulo | Nurse Practitioner | 1309 E Fall Ct, Boise, ID 83706-5076 | 2019-10-08 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1649824277 | Bryana Michel Hinck | Nurse Practitioner | 150 W Broderick Dr, Meridian, ID 83646-0009 | 2019-07-31 |
| Find all providers with the same taxonomy | ||||
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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.