Active NPI
Gem State Radiology LLP
- Diagnostic Radiology Physician
- Boise, ID
National Provider Identifier
1083661508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- GEM STATE RADIOLOGY LLP
- Practice address
- 1055 N Curtis Rd
Boise, ID 83706-1352 - Phone
- (208) 367-2161
- NPI assigned
- May 29, 2006
- Last updated
- Oct 17, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Wayne Baldwin
- Title
- Executive Director
- Phone
- (208) 384-9060
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | NU | Primary |
Addresses
Primary practice location
1055 N Curtis Rd
Boise, ID 83706-1352
Mailing address
877 W Main St Ste 603
Boise, ID 83702-6070
Phone (208) 954-8070
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002874800 | Medicaid | ID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ | Other | Management Services Network, LLC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID, OR, UT, VA, FL, AZ, GA, MA, WA, NV, MN, WI, TX, AK, IA, NC, NY, CO, CA
Enrollment records 19
National Provider Directory
National Provider DirectoryLocations
161 E Mallard Dr
Boise, ID 83706
Phone (208) 203-2781
161 E Mallard Dr
Ste 130
Boise, ID 83706
Phone (208) 384-9060
6200 W Emerald St
Boise, ID 83704
Phone (208) 367-3336
6533 W Emerald St
Boise, ID 83704
Phone (208) 302-5200
3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400
4424 E Flamingo Ave
#230
Nampa, ID 83687
Practitioners & affiliated clinicians
Practitioners 80
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.
-
- Family Nurse Practitioner
- Boise, ID
- NPI 1548784606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148860800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1792195200000",
"number": "1083661508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "877 W MAIN ST STE 603",
"city": "BOISE",
"state": "ID",
"postal_code": "837026070",
"telephone_number": "208-954-8070",
"fax_number": "208-954-8073"
},
{
"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": "837061352",
"telephone_number": "208-367-2161"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEM STATE RADIOLOGY LLP",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-29",
"last_updated": "2026-10-17",
"certification_date": "2026-10-17",
"status": "A",
"authorized_official_last_name": "BALDWIN",
"authorized_official_first_name": "WAYNE",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "208-384-9060",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002874800",
"state": "ID"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
"affiliation": "Y",
"endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
"affiliationName": "Management Services Network, LLC",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "2357 Warm Springs Rd Ste 400",
"city": "Columbus",
"state": "GA",
"country_code": "US",
"postal_code": "319046874",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}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 Oct 17, 2026; 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.