NPIMap

Organization Active NPI

Intermountain Ambulatory Anesthesia PLLC

  • Anesthesiology Physician
  • Meridian, ID
National Provider Identifier
1073546289
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
INTERMOUNTAIN AMBULATORY ANESTHESIA PLLC
Practice address
875 S Vanguard Way
Meridian, ID 83642-8540
Phone
(208) 373-5000
NPI assigned
Jul 9, 2006
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Dr. Kirk Miller, M.D.NPI 1124075056
Title
Member
Phone
(208) 960-0870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

875 S Vanguard Way
Meridian, ID 83642-8540

Mailing address

PO Box 3661
Seattle, WA 98124-3661
Phone (800) 475-6236

Other identifiers 1

IdentifierTypeStateIssuer
806036500MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000128 ID Part B Supplier - Clinic/Group Practice 0345235180 Receives reassigned benefits from 25 practitioners
Practice locations: Boise, ID; Meridian, ID

National Provider Directory

National Provider Directory

Locations

600 N Robbins Rd
Ste 4
Boise, ID 83702
Phone (208) 489-4279

1828 S Millenium Way
Ste 100
Meridian, ID 83642
Phone (208) 381-0262

875 S Vanguard Way
Ste 300
Meridian, ID 83642
Phone (208) 960-0650

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1073546289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3661",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243661",
            "telephone_number": "800-475-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S VANGUARD WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428540",
            "telephone_number": "208-373-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN AMBULATORY ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-960-0870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806036500",
            "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 Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.