NPIMap

Individual provider Active NPI

Bethany Joy Mello, NP-C

  • Family Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1033479696
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1639A Issued in ID
Practice address
951 E Plaza Dr Ste 170
Eagle, ID 83616-6569
Phone
(208) 939-3505
NPI assigned
May 16, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1639A ID Primary
Registered Nurse 163W00000X 51084 ID

Addresses

Primary practice location

951 E Plaza Dr Ste 170
Eagle, ID 83616-6569

Mailing address

951 E Plaza Dr Ste 170
Eagle, ID 83616-6569
Phone (208) 939-3505

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
I20160721001678 ID Practitioner - Nurse Practitioner 1850684309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gary Gregerson MD PAGroup PAC ID 3173838141, 10 clinicians

Practice addresses (Care Compare)

16111 N Brinson St
Suite 110
Nampa, ID 83687-5509
Phone (208) 468-9400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1639AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gary Gregerson, M.D., P.a. CurrentSince Feb 1, 2017 Accepting new patients
Gary Gregerson MD PA PastSince Feb 1, 2017 Accepting new patients

Locations

4850 N Rosepoint Way
Boise, ID 83713

4850 N Rosepoint Way
Ste 100
Boise, ID 83713
Phone (208) 393-2100

1611 12th Ave Rd
Ste A
Nampa, ID 83686
Phone (208) 468-9400

16111 N Brinson St
#110
Nampa, ID 83687
Phone (208) 468-9400

215 E Hawaii Ave
Ste 220
Nampa, ID 83686

Organizations & group practices 2

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.

Hospital & facility affiliations 10

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": "1337126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1033479696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR STE 170",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166569",
            "telephone_number": "208-939-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR STE 170",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166569",
            "telephone_number": "208-939-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLO",
        "first_name": "BETHANY",
        "middle_name": "JOY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-16",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "1639A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "51084",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.