Individual provider Active NPI

Bethany Kendall Maze, FNP

  • Family Nurse Practitioner
  • Boise, ID
National Provider Identifier
1053180976
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
60785 Issued in ID
Practice address
6051 W Emerald St
Boise, ID 83704-8969
Phone
(208) 302-5150
Fax
(208) 302-5155
NPI assigned
Dec 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 60785 ID Primary

Addresses

Primary practice location

6051 W Emerald St
Boise, ID 83704-8969

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

1150 N Sister Catherine Way
Nampa, ID 83687-3133
Phone (208) 302-7000

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
I20240210000572 ID Practitioner - Nurse Practitioner 0749623312 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

10583 W Lake Hazel Rd
Boise, ID 83709-6326
Phone (208) 302-5900

10717 W State St
Star, ID 83669-6046
Phone (208) 302-6300

11035 Karcher Rd
Nampa, ID 83651-8200
Phone (208) 302-2100

1150 N Sister Catherine Way
Nampa, ID 83687-3133
Phone (208) 302-7000

215 E Hawaii Ave
Nampa, ID 83686-6011

3025 W Cherry LN
Meridian, ID 83642-8531

6022 W Emerald St
Boise, ID 83704-8855
Phone (208) 367-4603

6094 W Emerald St
Boise, ID 83704-8855
Phone (208) 302-1000

712 Aviation Way
Caldwell, ID 83605-1154
Phone (208) 302-1035

757 E Wythe Creek CT
Suite 100
Kuna, ID 83634-5006
Phone (208) 302-6500

867 S Vanguard Way
Meridian, ID 83642-7552
Phone (208) 302-7950

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Mar 1, 2024 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Mar 1, 2024 Accepting new patients

Locations

6051 W Emerald St
Boise, ID 83704
Phone (208) 302-5100

910 NW 16th St
Ste 101
Fruitland, ID 83619
Phone (208) 452-8000

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

1150 N Sister Catherine Way
Nampa, ID 83687
Phone (208) 302-7000

Interoperability endpoints

  • Direct secure messaging: bmaze1570557@direct.trinity-health.org

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1703030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1053180976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048969",
            "telephone_number": "208-302-5150",
            "fax_number": "208-302-5155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 N Sister Catherine Way",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873133",
            "country_code": "US",
            "telephone_number": "208-302-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAZE",
        "first_name": "BETHANY",
        "middle_name": "KENDALL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-20",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "60785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.