ST LUKES REGIONAL MEDICAL CENTER (NPI# 1972627628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972627628 |
| Entity Type | Organization |
| Organization Name | ST LUKES REGIONAL MEDICAL CENTER |
| Other Organization Name | ST LUKES DEVELOPMENTAL PEDIATRICS |
| Practice Address |
100 E Idaho St Ste 200 Boise ID 83712-6223 |
| Mailing Address |
Po Box 550 Boise ID 83701-0550 |
| Practice Telephone | 2083817312 |
| Mailing Telephone | 2083817312 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JERRY HIRSCHFELD (ADMINISTRATOR) |
| Authorized Official Telephone | 2083812818 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
03 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | HOSPITAL STATE LIC # | 03 | 01 |
| Other Name | Type Code |
|---|---|
| ST LUKES DEVELOPMENTAL PEDIATRICS | Doing Business As Name - 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 STE 200 |
| City | BOISE |
| State | ID |
| Zip Code | 83712-6223 |
| 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 |
| Find all providers in the same location | ||||
| 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 | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407890031 | J Timothy Leavell | Pediatrics | 100 E Idaho St, Suite 200, Boise, ID 83712-6267 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326124488 | Stephen Allen Meyers | Pediatrics | 2275 W Broadway, Suite G, Idaho Falls, ID 83402 | 2006-10-31 |
| 1063405454 | Nancy Mann | Pediatrics | 1502 Locust St N Ste 700, Twin Falls, ID 83301-4164 | 2005-08-31 |
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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.