NPIMap

Individual provider Active NPI

Micheal George Adondakis, MD

  • Diagnostic Radiology Physician
  • Boise, ID
National Provider Identifier
1003306754
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M-17306 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-2121
Fax
(706) 596-6720
NPI assigned
May 17, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 69822 AZ
Diagnostic Radiology Physician 2085R0202X MD216181 OR
Diagnostic Radiology Physician 2085R0202X M-17306 ID Primary

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

877 W Main St Ste 603
Boise, ID 83702-6070
Phone (208) 954-8070

Other practice location 1

2910 N 3rd Ave
Phoenix, AZ 85013-4434
Phone (602) 406-7783

Other practice location 2

350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone (602) 406-3430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240522001997 ID Practitioner - Diagnostic Radiology 7416291026 Reassigns benefits to 2 organizations
I20240522002033 OR Practitioner - Diagnostic Radiology 7416291026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tufts University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gem State Radiology LLP 60 clinicians
Intermountain Medical Imaging LLC 35 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2161

3325 Pocahontas Rd
Baker City, OR 97814-1464
Phone (541) 523-8137

875 S Vanguard Way
Suite 100
Meridian, ID 83642-8541
Phone (208) 954-8100

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052
  • St. Alphonsus Medical Center - Baker City Hospital, Baker City, OR, CCN 381315
  • Treasure Valley Hospital Hospital, Boise, ID, CCN 130063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Smi Imaging, LLC Diagnostic Radiology CurrentSince Jul 17, 2023 Accepting new patients
Intermountain Medical Imaging LLC Diagnostic Radiology Past Accepting new patients
Intermountain Medical Imaging LLC Diagnostic Radiology Past Accepting new patients

Locations

20414 N 27th Ave
Ste 150
Phoenix, AZ 85027
Phone (623) 234-2520

1845 W Orange Grove Rd
Ste 103
Tucson, AZ 85704
Phone (520) 230-4900

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1003306754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 W MAIN ST STE 603",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026070",
            "telephone_number": "208-954-8070",
            "fax_number": "208-954-8073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-2121",
            "fax_number": "706-596-6720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2910 N 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134434",
            "country_code": "US",
            "telephone_number": "602-406-7783",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 W Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134409",
            "country_code": "US",
            "telephone_number": "602-406-3430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADONDAKIS",
        "first_name": "MICHEAL",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-17",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "69822",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD216181",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M-17306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.