Organization Active NPI

Vision Care Center of Idaho LLC

  • Ambulatory Surgical Clinic/Center
  • Meridian, ID
National Provider Identifier
1083674196
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
VISION CARE CENTER OF IDAHO LLC
Practice address
3071 E Franklin Rd
Suite 101
Meridian, ID 83642-2376
Phone
(208) 288-1400
Fax
(208) 855-0104
NPI assigned
Mar 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Authorized official

Name
Mrs. Nancy McHugh
Title
Administrator
Phone
(208) 288-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3071 E Franklin Rd
Suite 101
Meridian, ID 83642-2376

Mailing address

3071 E Franklin Rd
Suite 101
Meridian, ID 83642-2376
Phone (208) 288-1400

Other identifiers 4

IdentifierTypeStateIssuer
000010029517OtherIDBLUE SHILED
FIRST HEALTH CCNOtherID2090664
04101OtherIDBLUE CROSS
805861000MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100715000703 ID Part B Supplier - Ambulatory Surgical Center 7214069913 Practice locations: Meridian, ID

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Vision Care Center of Idaho LLCCCN 13C0001034
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0975825Vision Care Center of Idaho3071 E Franklin Rd Ste 101, Meridian, ID 83642Certificate of waiverJul 18, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1083674196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3071 E FRANKLIN RD",
            "address_2": "SUITE 101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422376",
            "telephone_number": "208-288-1400",
            "fax_number": "208-855-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3071 E FRANKLIN RD",
            "address_2": "SUITE 101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422376",
            "telephone_number": "208-288-1400",
            "fax_number": "208-855-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION CARE CENTER OF IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "MCHUGH",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-288-1400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHILED",
            "identifier": "000010029517",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "2090664",
            "identifier": "FIRST HEALTH CCN",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "04101",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805861000",
            "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 Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.