Individual provider Active NPI

Michael Vincen-Brown, PA-C

  • Physician Assistant
  • Nampa, ID
National Provider Identifier
1003326398
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1538 Issued in ID
Practice address
1115 12TH Ave
Nampa, ID 83686
Phone
(208) 498-1080
Fax
(208) 498-1081
NPI assigned
Oct 2, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1538 ID Primary

Addresses

Primary practice location

1115 12TH Ave
Nampa, ID 83686

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 985-1399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171108003370 ID Practitioner - Physician Assistant 2062778939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians

Practice addresses (Care Compare)

10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500

11197 W Fairview Ave
Boise, ID 83713-7935
Phone (208) 378-8011

1375 N Happy Valley Rd
Nampa, ID 83687-5280
Phone (208) 809-2869

1474 N Meridian Rd
Kuna, ID 83634-2041
Phone (208) 809-2885

1475 N Cole Rd
Boise, ID 83704-8537
Phone (208) 809-2880

1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860

260 S Ten Mile Rd
Meridian, ID 83642-6100
Phone (208) 809-2872

4971 W Overland Rd
Boise, ID 83705-2822
Phone (208) 472-5050

512 N 21St Ave
Caldwell, ID 83605-4368
Phone (208) 809-2875

6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947

8971 W Overland Rd
Boise, ID 83709-1651
Phone (208) 378-4288

Merit-based Incentive Payment System (MIPS)

Final score
84.87 of 100Reported as group
Quality
77.29
Promoting interoperability
97
Improvement activities
40
Cost
74.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-1538IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC Family Medicine Current Accepting new patients
Alliance Medical Group, LLC Family Medicine CurrentSince Oct 30, 2017 Accepting new patients
Alliance Medical Group, LLC Family Medicine Past Accepting new patients

Locations

435 S Eagle Rd
Ste 100
Eagle, ID 83616
Phone (208) 609-9130

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

3115 E Florence Dr
Meridian, ID 83642
Phone (208) 378-4288

3280 E Lanark Dr
Meridian, ID 83642
Phone (208) 377-4400

1115 12th Ave Rd
Nampa, ID 83686
Phone (208) 498-1080

Interoperability endpoints

  • Direct secure messaging: michael.vincenbrown@phmg.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/GJDCAA
  • FHIR API: https://fhir4.healow.com/fhir/r4/GJDCAA/Endpoint/GJDCAA

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1003326398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-985-1399",
            "fax_number": "208-985-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 12TH AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-498-1080",
            "fax_number": "208-498-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCEN-BROWN",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-02",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.