Active NPI
Karen Porth, M.D.
- Neurology Physician
- Boise, ID
National Provider Identifier
1033179288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- M-12653
- Practice address
- 1072 N Liberty Street
Ste 303
Boise, ID 83704 - Phone
- (208) 367-2800
- Fax
- (208) 367-7111
- NPI assigned
- Mar 23, 2006
- Last updated
- Oct 21, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 8482 | MT | |
| Neurology Physician | 2084N0400X | M-12653 | ID | Primary |
Addresses
Primary practice location
1072 N Liberty Street
Ste 303
Boise, ID 83704
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-2800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121828000 | Medicaid | WY |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8482 | MT | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Alphonsus Specialty Services Inc | Neurology | Past | Accepting new patients |
Interoperability endpoints
- kporth1563140@direct.trinity-health.org
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": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413849600000",
"number": "1033179288",
"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": "208-367-2800",
"fax_number": "208-367-7111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1072 N LIBERTY STREET",
"address_2": "STE 303",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-367-2800",
"fax_number": "208-367-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTH",
"first_name": "KAREN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2014-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MT",
"license": "8482",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "ID",
"license": "M-12653",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121828000",
"state": "WY"
}
],
"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 Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.