NPIMap

Organization Active NPI

Idaho Center for Reproductive Medicine PC

  • Reproductive Endocrinology Physician
  • Boise, ID
National Provider Identifier
1063551174
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
M7577 Issued in ID
Legal business name
IDAHO CENTER FOR REPRODUCTIVE MEDICINE PC
Practice address
111 Main St
Suite 100
Boise, ID 83702-7307
Phone
(208) 342-5900
Fax
(208) 342-2088
NPI assigned
Feb 5, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Genie T Andrews
Title
Bus Admin
Phone
(208) 342-5900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology Physician 207VE0102X M8614 ID
Reproductive Endocrinology Physician 207VE0102X M7577 ID Primary

Addresses

Primary practice location

111 Main St
Suite 100
Boise, ID 83702-7307

Mailing address

111 Main St
Suite 100
Boise, ID 83702-7307
Phone (208) 342-5900

Other identifiers 3

IdentifierTypeStateIssuer
8G189OtherIDBLUE CROSS CLINIC
51292OtherIDBLUE CROSS DR SLATER
513COOtherIDBLUE CROSS DR FOULK

Other names 1

  • ICRM PC Other name

National Provider Directory

National Provider Directory

Locations

1000 E Park Blvd
Ste 110
Boise, ID 83712
Phone (208) 342-5900

3875 E Overland Rd
Ste 103
Meridian, ID 83642

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063551174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MAIN ST",
            "address_2": "SUITE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027307",
            "telephone_number": "208-342-5900",
            "fax_number": "208-342-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MAIN ST",
            "address_2": "SUITE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027307",
            "telephone_number": "208-342-5900",
            "fax_number": "208-342-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO CENTER FOR REPRODUCTIVE MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "GENIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "BUS ADMIN",
        "authorized_official_telephone_number": "208-342-5900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "ID",
            "license": "M8614",
            "primary": false
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "ID",
            "license": "M7577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS CLINIC",
            "identifier": "8G189",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS DR SLATER",
            "identifier": "51292",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS DR FOULK",
            "identifier": "513CO",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICRM PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.