Active NPI
Gary D Musgrave, D.C.
- Sports Physician Chiropractor
- Boise, ID
National Provider Identifier
1003930967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- CHIA-1306
- Practice address
- 3314 N. Cole Rd.
Boise, ID 83704 - Phone
- (208) 377-9930
- Fax
- (208) 377-9932
- NPI assigned
- Mar 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | CHIA-1306 | ID | Primary |
| Sports Physician Chiropractor | 111NS0005X | 1586 | OH |
Addresses
Primary practice location
3314 N. Cole Rd.
Boise, ID 83704
Mailing address
3314 N. Cole Rd.
Boise, ID 83704
Phone (208) 377-9930
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341690892-00 | Other | OH | BWC |
| 000000136764 | Other | OH | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-1306 | ID | MD | Sports Physician Chiropractor |
| 1586 | OH | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boise Sports Chiropractic Clinic | Sports Physician | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233705600000",
"number": "1003930967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3314 N. COLE RD.",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-377-9930",
"fax_number": "208-377-9932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3314 N. COLE RD.",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-377-9930",
"fax_number": "208-377-9932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSGRAVE",
"first_name": "GARY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-18",
"last_updated": "2009-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "ID",
"license": "CHIA-1306",
"primary": true
},
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "OH",
"license": "1586",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BWC",
"identifier": "341690892-00",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000136764",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.