SANDRA KASUMOVIC (NPI# 1780009506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1780009506 |
Entity Type | Individual |
Full Name | SANDRA KASUMOVIC |
Credential | PA-C |
Practice Address |
12273 West Mcmillan Road Boise ID 83713 |
Mailing Address |
3340 E Goldstone Way Meridian ID 83642-1026 |
Practice Telephone | 2083676330 |
Practice Fax Number | 2083674765 |
Mailing Telephone | 2083676330 |
Mailing Fax Number | 2083674765 |
Enumeration Date | 2014-03-03 |
Last Update Date | 2014-10-17 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363A00000X | Physician Assistant | PA1136 | ID | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA1136 | ID | Physician Assistants & Advanced Practice Nursing Providers |
N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA1136 | ID | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
12273 WEST MCMILLAN ROAD |
City | BOISE |
State | ID |
Zip Code | 83713 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
1720248305 | James Benjamin Earl | Ophthalmology | 13923 W. Wainwright Dr Ste 301, Boise, ID 83713 | 2008-06-17 |
Find all providers in zip 83713 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
1710231238 | Alaina A Mccoy | Physician Assistant | 100 E. Idaho St., Suite 400, Boise, ID 83712 | 2012-11-06 |
1447534821 | Addie Barnes | Physician Assistant | 900 N Liberty, Ste 101, Boise, ID 83704 | 2011-10-04 |
1134358104 | Eric Culbertson | Physician Assistant | 633n 4th St, Boise, ID 83702-4510 | 2009-07-10 |
1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
1598921595 | Karen B. Barrett | Physician Assistant | 6000 W. Overland Road, Firstline Medical, Boise, ID 83704 | 2008-07-30 |
1972672111 | Kara Mcgee | Physician Assistant | 727 E Riverpark Ln Ste 200, Boise, ID 83706-4097 | 2006-11-06 |
1265464036 | Sharene E Watsen | Physician Assistant | 403 South 11th St, Ste 100, Boise, ID 83702-6906 | 2006-07-06 |
1508802091 | Heidi R Munro | Physician Assistant | 8000 S Federal Way, Boise, ID 83716-9632 | 2006-06-22 |
Find all providers in BOISE |
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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.