Active NPI
Thiago Alberto, NP
- Nurse Practitioner
- Boise, ID
National Provider Identifier
1023650512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 62877
- Practice address
- 11197 W Fairview Ave
Boise, ID 83713-7935 - Phone
- (208) 378-8011
- NPI assigned
- Oct 16, 2019
- Last updated
- Jul 13, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 62877 | ID | Primary |
Addresses
Primary practice location
11197 W Fairview Ave
Boise, ID 83713-7935
Mailing address
PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500
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)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellspring Behavioral Health, Inc | Past | Accepting new patients |
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.
-
- Psychiatric/Mental Health Nurse Practitioner
- Eagle, ID
- NPI 1124642293
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626134400000",
"number": "1023650512",
"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": "208-955-6500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11197 W FAIRVIEW AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837137935",
"telephone_number": "208-378-8011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALBERTO",
"first_name": "THIAGO",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-16",
"last_updated": "2021-07-13",
"certification_date": "2021-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "ID",
"license": "62877",
"primary": true
}
],
"identifiers": [],
"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 Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.