Individual provider Active NPI

Michael P Lorentzen, NP

  • Nurse Practitioner
  • Boise, ID
National Provider Identifier
1033638150
Registry record updated Sep 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
56892 Issued in ID
Practice address
190 E Bannock St FL 9
Boise, ID 83712-6241
Phone
(208) 381-2222
NPI assigned
Sep 11, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 56892 ID Primary

Addresses

Primary practice location

190 E Bannock St FL 9
Boise, ID 83712-6241

Mailing address

2312 N 16TH St
Boise, ID 83702-1227
Phone (208) 490-0616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171201001767 ID Practitioner - Nurse Practitioner 0547527475 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56892IDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Regional Medical Center Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506729600000",
    "number": "1033638150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 N 16TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837021227",
            "telephone_number": "208-490-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST FL 9",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORENTZEN",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-11",
        "last_updated": "2017-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "56892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.