NPIMap

Individual provider Active NPI

Polina Kokoulina, PA-C

  • Surgical Physician Assistant
  • Boise, ID
National Provider Identifier
1013342468
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-1093 Issued in ID
Practice address
900 N Liberty St
Ste 101
Boise, ID 83704-8704
Phone
(208) 367-5050
Fax
(208) 367-5151
NPI assigned
Sep 4, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA-1093 ID Primary

Addresses

Primary practice location

900 N Liberty St
Ste 101
Boise, ID 83704-8704

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131108000316 ID Practitioner - Physician Assistant 4183859606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center Inc 672 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

3025 W Cherry LN
Meridian, ID 83642-8531

712 Aviation Way
Caldwell, ID 83605-1154
Phone (208) 302-1035

900 N Liberty St
Suite 101
Boise, ID 83704-8858
Phone (208) 302-2200

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 23, 2013 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 23, 2013 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Surgical Past Accepting new patients
Idaho Emergency Physicians, P.a. PastSince Dec 1, 2011 Accepting new patients
Saint Alphonsus Specialty Services Inc Past Accepting new patients

Locations

900 N Liberty St
Ste 101
Boise, ID 83704
Phone (208) 302-2200

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: pkokoulina1564404@direct.trinity-health.org

Organizations & group practices 7

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 5

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": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1013342468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5050",
            "fax_number": "208-367-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N LIBERTY ST",
            "address_2": "STE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048704",
            "telephone_number": "208-367-5050",
            "fax_number": "208-367-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOKOULINA",
        "first_name": "POLINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-1093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.