NPIMap

Individual provider Active NPI

Micah Ray Tobin, PA

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1013568468
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1776 Issued in ID
Practice address
10583 W Lake Hazel Rd
Boise, ID 83709
Phone
(208) 302-5950
Fax
(208) 302-5955
NPI assigned
Sep 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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-1776 ID Primary

Addresses

Primary practice location

10583 W Lake Hazel Rd
Boise, ID 83709

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

323 E Riverside Dr Ste 224
Eagle, ID 83616-6865
Phone (208) 302-3500

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
I20191204002710 ID Practitioner - Physician Assistant 9931532991 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 N Curtis
Boise, ID 83706-1309

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

3025 W Cherry LN
Meridian, ID 83642-8531

6165 W Emerald St
Boise, ID 83704-8613
Phone (208) 302-3500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-1776IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Physician Assistant CurrentSince Oct 1, 2019 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 1, 2019 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Jul 1, 2022 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Jul 1, 2022 Accepting new patients

Locations

6165 W Emerald St
Boise, ID 83704
Phone (208) 302-3500

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

10583 W Lake Hazel Rd
Boise, ID 83709
Phone (208) 302-5900

323 E Riverside Dr
Ste 224
Eagle, ID 83616
Phone (208) 302-6000

910 NW 16th St
Ste 101
Fruitland, ID 83619
Phone (208) 452-8000

875 S Vanguard Way
Ste 120
Meridian, ID 83642
Phone (208) 367-6416

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

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

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

Interoperability endpoints

  • Direct secure messaging: mtobin1564120@direct.trinity-health.org

Organizations & group practices 5

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 6

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": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1013568468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-302-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10583 W LAKE HAZEL RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83709",
            "telephone_number": "208-302-5950",
            "fax_number": "208-302-5955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 E Riverside Dr Ste 224",
            "address_purpose": "LOCATION",
            "city": "Eagle",
            "state": "ID",
            "postal_code": "836166865",
            "country_code": "US",
            "telephone_number": "208-302-3500",
            "fax_number": "208-302-3555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOBIN",
        "first_name": "MICAH",
        "middle_name": "RAY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-26",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.