Idaho Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

IDAHO ENDOSCOPY CENTER LLC

Doing business as

Nampa Idaho Endoscopy Center

Practice address

5080 E Commerce St
Nampa, ID 83687-5513

Phone

(986) 867-1600

Fax

(986) 867-1601

NPI assigned

Jun 9, 2020

Last updated

Jul 30, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

IDAHO ENDOSCOPY CENTER LLCAs reported in NPPES

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

Authorized official

Name

Mark A Mallory, MDNPI 1336116888

Title

Manager

Phone

(208) 489-1900

Specialties & licenses 1

Addresses

Other names 1

• Nampa Idaho Endoscopy Center Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Idaho Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Boise, ID
  • NPI 1750616249

  9335270966

  Same PAC ID

Listed as

Nampa Idaho Endoscopy CenterCCN 13C0001085

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Idaho Endoscopy Center LLC2 organizations share this tax ID, including this one

Part of

Idaho Endoscopy Center LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Idaho Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Boise, ID
  • NPI 1750616249
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Digestive Health Clinic LLC

  dba Nampa Digestive Health Clinic

  • Gastroenterology Physician
  • Nampa, ID
  • NPI 1891310561

  Member Of

  NPD member

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Idaho Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Boise, ID
  • NPI 1750616249
  NPPES parent name

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark A Mallory, M.D.

  • Gastroenterology Physician
  • Boise, ID
  • NPI 1336116888
  Authorized official Same address or phone
• Bryan Basil Brimhall, M.D.

  • Gastroenterology Physician
  • Boise, ID
  • NPI 1902195753
  NPD
• Robb F Gibson, M.D.

  • Gastroenterology Physician
  • Boise, ID
  • NPI 1538128707
  NPD (past)
• Samuel S Gibson, M.D.

  • Gastroenterology Physician
  • Boise, ID
  • NPI 1275500738
  NPD (past)

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1043835713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6259 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048731",
            "telephone_number": "208-489-1900",
            "fax_number": "208-489-1929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5080 E COMMERCE ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875513",
            "telephone_number": "986-867-1600",
            "fax_number": "986-867-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO ENDOSCOPY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDAHO ENDOSCOPY CENTER LLC",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "MALLORY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-489-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nampa Idaho Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nampa Idaho Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Idaho Dental Aid, PLLC
• Idaho Department of Health & Welfare (State Hospital West)
• Idaho Department of Health and Welfare Esc Region III
• Idaho Dept of Health & Welfare Itp Region 3
• Idaho Em-I Medical Services PC
• Idaho Eye Pros of Nampa
• Idaho Family Physical Therapy PLLC (Idaho Family PT)
• Idaho Medical Products
• Idaho Medical Products
• Idaho Mental Wellness & Addiction Recovery PLLC

• Ambulatory Surgical Clinic/Center in Nampa, ID
• Providers in Nampa, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.