Individual provider Active NPI

Taylor Jene Mellinger, DO

  • Internal Medicine Physician
  • Boise, ID
National Provider Identifier
1063271492
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MRO-2357 Issued in ID
Practice address
500 W Fort St # 111R
Boise, ID 83702-4599
Phone
(208) 422-1000
Fax
(208) 422-1536
NPI assigned
Mar 18, 2024
Last updated
Apr 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MRO-2357 ID Primary

Addresses

Primary practice location

500 W Fort St # 111R
Boise, ID 83702-4599

Mailing address

500 W Fort St # 111R
Boise, ID 83702-4599
Phone (208) 422-1000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240509002495 ID Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 5193166023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1063271492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W FORT ST # 111R",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024599",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W FORT ST # 111R",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024599",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLINGER",
        "first_name": "TAYLOR",
        "middle_name": "JENE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "MRO-2357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.