NPIMap

Individual provider Active NPI

Bruce J Andersen, MD

  • Neurological Surgery Physician
  • Boise, ID
National Provider Identifier
1063420792
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
M-7767 Issued in ID
Practice address
1072 N Liberty St
Suite 303
Boise, ID 83704-2800
Phone
(208) 367-4035
Fax
(208) 367-7111
NPI assigned
Aug 5, 2006
Last updated
Feb 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X M7767 ID
Neurological Surgery Physician 207T00000X M-7767 ID Primary

Addresses

Primary practice location

1072 N Liberty St
Suite 303
Boise, ID 83704-2800

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170

Other practice location 1

3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone (952) 993-3230

Other identifiers 8

IdentifierTypeStateIssuer
134024OtherOROMAP
145403OtherWAWA DEPARTMENT OF LABOR
72504OtherBLUE CROSS OF IDAHO
805457400MedicaidID
185529500OtherUS DEPARTMENT OF LABOR
807732500MedicaidID
8J703OtherIDBLUE CROSS OF IDAHO GROUP
000010026334OtherIDREGENCE BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, MN, GA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20031105000773 ID Practitioner - Neurosurgery 3678485760 Reassigns benefits to 1 organization
I20230321001831 MN Practitioner - Neurosurgery 3678485760 Reassigns benefits to 2 organizations
I20250714001122 GA Practitioner - Neurosurgery 3678485760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Northwestern University Feinberg Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

2621 Greenhaven Rd
Anoka, MN 55303-1776
Phone (952) 853-8800

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M7767IDMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Apr 13, 2023 Accepting new patients
Pocatello Health Services, LLC CurrentSince Sep 15, 2025 Accepting new patients
Pocatello Health Services, LLC CurrentSince Sep 15, 2025 Accepting new patients
Group Health, Inc. CurrentSince Apr 13, 2023 Accepting new patients
Pocatello Health Services, LLC Current Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. CurrentSince Jun 26, 2025 Accepting new patients
Group Health, Inc. Current Accepting new patients
Pocatello Hospital LLC Current Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. CurrentSince Jun 26, 2025 Accepting new patients
Group Health, Inc. CurrentSince Apr 13, 2023 Accepting new patients

Locations

1538 13th Ave
Ste B300
Columbus, GA 31901

1800 10th Ave
Columbus, GA 31901
Phone (706) 571-1120

777 Hospital Way
Ste 201
Pocatello, ID 83201
Phone (208) 239-2260

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

3931 Louisiana Ave S
St Louis Park, MN 55426
Phone (952) 993-3230

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1063420792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "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": "1072 N LIBERTY ST",
            "address_2": "SUITE 303",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837042800",
            "telephone_number": "208-367-4035",
            "fax_number": "208-367-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3931 Louisiana Ave S",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554265000",
            "country_code": "US",
            "telephone_number": "952-993-3230",
            "fax_number": "952-993-1748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "BRUCE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "ID",
            "license": "M7767",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "ID",
            "license": "M-7767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP",
            "identifier": "134024",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DEPARTMENT OF LABOR",
            "identifier": "145403",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "72504",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805457400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "185529500",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807732500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO GROUP",
            "identifier": "8J703",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010026334",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.