ST LUKES REGIONAL MEDICAL CENTER (NPI# 1912036005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912036005 |
| Entity Type | Organization |
| Organization Name | ST LUKES REGIONAL MEDICAL CENTER |
| Other Organization Name | ST LUKES HEMOPHILIA CENTER |
| Practice Address |
100 E Idaho St Boise ID 83712-6267 |
| Mailing Address |
Po Box 640 Boise ID 83701-0640 |
| Practice Telephone | 2083812222 |
| Mailing Telephone | 2083812222 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2016-09-30 |
| Authorized Official Name | JEFF TAYLOR (SYSTEM VP CFO) |
| Authorized Official Telephone | 2083812520 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
03 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | STATE LIC # | 03 | 01 |
| Other Name | Type Code |
|---|---|
| St Lukes Hemophilia Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639356173 | St Lukes Regional Medical Center | Family Medicine | 11311 W Chinden Blvd, Boise, ID 83714-1021 | 2008-01-28 |
| 1023201084 | St Lukes Regional Medical Center | Clinic/Center | 100 E Idaho St Ste 200, Boise, ID 83712-6270 | 2007-08-23 |
| 1770586794 | St Lukes Regional Medical Center | Pharmacy | 190 E Bannock St, Boise, ID 83712-6241 | 2005-05-23 |
| 1003295452 | St Lukes Regional Medical Center | Dietitian, Registered | 1226 W River St, Boise, ID 83702-7049 | 2015-05-19 |
| 1093109100 | St Lukes Regional Medical Center | Clinical Medical Laboratory | 3176 S Denver Way, Boise, ID 83705-5289 | 2015-03-26 |
| 1477954204 | St Lukes Regional Medical Center | Ambulance | 895 N 6th E, Mountain Home, ID 83647-2207 | 2014-09-11 |
| 1730505199 | St Lukes Regional Medical Center | Rehabilitation Unit | 600 N Robbins Rd, Boise, ID 83702-4565 | 2014-03-10 |
| 1093131450 | St Lukes Regional Medical Center | Skilled Nursing Facility | 600 N Robbins Rd, Boise, ID 83702-4565 | 2014-03-10 |
| 1326388737 | St Lukes Regional Medical Center | Surgery | 895 N 6th E, Mountain Home, ID 83647-2207 | 2013-02-21 |
| 1710226451 | St Lukes Regional Medical Center | Medicare Defined Swing Bed Unit | 895 N 6th E, Mountain Home, ID 83647-2207 | 2013-01-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST LUKES REGIONAL MEDICAL CENTER SIOUX CITY | 2720 Stone Park Blvd, Sioux City, IA 51104-3734 |
| Street Address |
100 E IDAHO ST |
| City | BOISE |
| State | ID |
| Zip Code | 83712-6267 |
| 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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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| Find all providers in zip 83712 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568805810 | Nicholas Tyler Gorden | Internal Medicine | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2013-04-16 |
| 1184733917 | Paul G Montgomery | Internal Medicine | 100 E Idaho St, Boise, ID 83712-6267 | 2006-08-29 |
| 1821010455 | William H Kreisle | Internal Medicine | 100 E Idaho St, Boise, ID 83712-6267 | 2006-07-24 |
| 1568484053 | Norman Zuckerman | Internal Medicine | 100 E Idaho St, Boise, ID 83712-6267 | 2006-07-24 |
| 1821016718 | Theodore A Walters | Internal Medicine | 100 E Idaho St, Boise, ID 83712-6267 | 2006-07-18 |
| 1790717742 | Thomas M Beck | Internal Medicine | 100 E Idaho St, Boise, ID 83712-6267 | 2006-07-07 |
| 1376596247 | Kerry P Pulver | Internal Medicine | 1055 N Curtis Rd, Boise, ID 83706 | 2006-05-19 |
| 1992760664 | Andrew S Pierson | Internal Medicine | 1055 N Curtis Rd, Boise, ID 83706 | 2006-04-18 |
| 1023093507 | Dan S Zuckerman | Internal Medicine | 100 E Idaho St, Boise, ID 83712-6223 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891857512 | Nathan Bradley Adams | Internal Medicine | 2330 Desoto St, Idaho Falls, ID 83404-7570 | 2006-12-16 |
| 1669565669 | A. Richard Miranda | Internal Medicine | 706 N College Rd, Suite A, Twin Falls, ID 83301-5824 | 2006-10-02 |
| 1528075744 | Thomas J Leavitt | Internal Medicine | 284 Buck Run, Sagle, ID 83860 | 2006-08-01 |
| 1669497194 | Dane J Dickson | Internal Medicine | 380 Walker Drive, Rexburg, ID 83440 | 2006-07-13 |
| 1588696538 | Jonathan N Swerdloff | Internal Medicine | 308 E Hawaii Ave, Nampa, ID 83686-6013 | 2006-07-07 |
| 1508809252 | Daniel E Williams | Internal Medicine | 1250 Idaho St, Lewiston, ID 83501-1965 | 2006-06-13 |
| 1871558239 | Michael L Francisco | Internal Medicine | 651 Memorial Dr, Portneuf Cancer Center, Pocatello, ID 83201 | 2006-04-19 |
| 1669462362 | Mountain View Hospital LLC | Internal Medicine | 2325 Coronado St, Idaho Falls, ID 83404-7407 | 2005-10-24 |
| 1952307605 | David W. Ririe | Internal Medicine | 500 S 11th Ave Ste 100, Pocatello, ID 83201-4877 | 2005-06-27 |
| 1477020303 | Maria Teresa Cervantes-fullmer | Internal Medicine | 3245 Channing Way, Idaho Falls, ID 83404-7536 | 2018-10-29 |
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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.