Individual provider Active NPI

Kim Wilson, PA-C

  • Surgical Physician Assistant
  • Boise, ID
National Provider Identifier
1073982245
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA1456 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-8855
Fax
(208) 367-2989
NPI assigned
Sep 17, 2015
Last updated
Nov 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X NU
Surgical Physician Assistant 363AS0400X PA1456 ID Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170112002100 OR Practitioner - Physician Assistant 7012299738 Reassigns benefits to 3 organizations
I20170118001252 ID Practitioner - Physician Assistant 7012299738 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, shared by 4 NPIs, 672 clinicians
Gem State Radiology LLPGroup PAC ID 9335044833, 60 clinicians
Direct Orthopedic Care LLCGroup PAC ID 2163648155, 32 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

16818 N Marketplace Blvd
Nampa, ID 83687-5140
Phone (208) 321-4000

1789 S Broadway Ave
Suite 100
Boise, ID 83706-3800
Phone (208) 321-4000

3015 E Magic View Dr
Meridian, ID 83642-3743
Phone (208) 321-4000

3025 W Cherry LN
Meridian, ID 83642-8531

3175 Pocahontas Rd
Baker City, OR 97814-1434
Phone (208) 302-2200

3325 Pocahontas Rd
Baker City, OR 97814-1464
Phone (541) 523-8137

351 SW 9TH St
Ontario, OR 97914-2639
Phone (541) 881-7000

4300 E Flamingo Ave
Nampa, ID 83687-3138
Phone (208) 205-1000

4400 E Flamingo Ave
Nampa, ID 83687-9203
Phone (208) 288-4620

4842 N Cortona Way
Suite 110
Meridian, ID 83646-3171
Phone (208) 321-4000

7979 W Rifleman St
Suite 110
Boise, ID 83704-9066
Phone (208) 321-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1456IDMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Imaging LLC CurrentSince Sep 16, 2019 Accepting new patients
Direct Orthopedic Care LLC CurrentSince Dec 15, 2023 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Intermountain Medical Imaging LLC CurrentSince Sep 16, 2019 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 1, 2025 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Surgical CurrentSince Dec 1, 2025 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 1, 2025 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

6200 W Emerald St
Boise, ID 83704
Phone (208) 367-3336

7979 W Rifleman St
Boise, ID 83704
Phone (208) 321-4000

7979 W Rifleman St
Ste 110
Boise, ID 83704
Phone (208) 321-4000

877 W Main St
Ste 603
Boise, ID 83702
Phone (208) 367-2161

927 W Myrtle St
Boise, ID 83702
Phone (208) 367-7510

1717 Arlington Ave
Caldwell, ID 83605
Phone (208) 455-3719

323 E Riverside Dr
Ste 108
Eagle, ID 83616
Phone (208) 367-5700

2929 E Magic View Dr
Meridian, ID 83642
Phone (208) 367-8222

3015 E Magic View Dr
Ste 130
Meridian, ID 83642
Phone (208) 482-5567

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

875 S Vanguard Way
Ste 100
Meridian, ID 83642
Phone (208) 954-8100

4300 E Flamingo Ave
Nampa, ID 83687
Phone (208) 205-1000

3175 Pocahontas Rd
Baker City, OR 97814
Phone (208) 302-2200

3325 Pocahontas Rd
Baker City, OR 97814
Phone (541) 523-1797

1050 SW 3rd Ave
Ste 1600
Ontario, OR 97914
Phone (541) 881-2360

351 SW 9th St
Ontario, OR 97914
Phone (541) 881-7000

Organizations & group practices 10

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 9

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": "1442448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1073982245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "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": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-8855",
            "fax_number": "208-367-2989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-17",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA1456",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.