Individual provider Active NPI

John T Witte, M.D.

  • Gastroenterology Physician
  • Meridian, ID
National Provider Identifier
1063407641
Registry record updated Sep 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
M-5529 Issued in ID
Practice address
2235 E Gala St
Meridian, ID 83642-8026
Phone
(208) 887-3724
Fax
(208) 887-3724
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X M-5529 ID Primary

Addresses

Primary practice location

2235 E Gala St
Meridian, ID 83642-8026

Mailing address

425 W Bannock St
Boise, ID 83702-6035
Phone (208) 343-1702

Other practice location 1

425 W Bannock St
Boise, ID 83702-6035
Phone (208) 343-6458

Other practice location 2

9850 St Lukes Dr
Nampa, ID 83687-7912
Phone (208) 343-6458

Other practice location 3

1200 Garrity Blvd
Nampa, ID 83687-3402
Phone (208) 343-6458

Other identifiers 4

IdentifierTypeStateIssuer
000010005904OtherIDBLUE SHIELD OF IDAHO
002733600MedicaidID
55293OtherIDBLUE CROSS OF IDAHO
100001868OtherIDRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Boise Endoscopy Center, LLC PastSince Dec 1, 1998 Accepting new patients

Organizations & group practices 1

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537488000000",
    "number": "1063407641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026035",
            "telephone_number": "208-343-1702",
            "fax_number": "208-342-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 E GALA ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428026",
            "telephone_number": "208-887-3724",
            "fax_number": "208-887-3724"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 W Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026035",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-343-5031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9850 St Lukes Dr",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836877912",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-343-5031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Garrity Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873402",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-343-5031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WITTE",
        "first_name": "JOHN",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2018-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ID",
            "license": "M-5529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010005904",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002733600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "55293",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100001868",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.