Active NPI
John T Witte, M.D.
- Gastroenterology Physician
- Meridian, ID
National Provider Identifier
1063407641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- M-5529
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010005904 | Other | ID | BLUE SHIELD OF IDAHO |
| 002733600 | Medicaid | ID | |
| 55293 | Other | ID | BLUE CROSS OF IDAHO |
| 100001868 | Other | ID | RAILROAD 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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boise Endoscopy Center, LLC | Past | 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.
-
- Ambulatory Surgical Clinic/Center
- Meridian, ID
- NPI 1912992900
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.