Active NPI
Casi McPherson Wyatt, DO
- Infectious Disease Physician
- Boise, ID
National Provider Identifier
1083716153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- O-0530
- Practice address
- 125 E Idaho St
Suite 203
Boise, ID 83712-6212 - Phone
- (208) 338-0148
- Fax
- (208) 336-4027
- NPI assigned
- Sep 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 3714 | IA | |
| Infectious Disease Physician | 207RI0200X | O-0530 | ID | Primary |
Addresses
Primary practice location
125 E Idaho St
Suite 203
Boise, ID 83712-6212
Mailing address
125 E Idaho St
Suite 203
Boise, ID 83712-6212
Phone (208) 338-0148
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26705 | Other | IA | WELLMARK BCBS |
| 0731364 | Medicaid | IA |
Other names 1
- Casi Lynn McPherson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090804000393 | ID | Practitioner - Infectious Disease | 9931106176 | Practice locations: Boise, ID |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3714 | IA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244505600000",
"number": "1083716153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E IDAHO ST",
"address_2": "SUITE 203",
"city": "BOISE",
"state": "ID",
"postal_code": "837126212",
"telephone_number": "208-338-0148",
"fax_number": "208-336-4027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 E IDAHO ST",
"address_2": "SUITE 203",
"city": "BOISE",
"state": "ID",
"postal_code": "837126212",
"telephone_number": "208-338-0148",
"fax_number": "208-336-4027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "CASI",
"middle_name": "MCPHERSON",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-01",
"last_updated": "2009-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IA",
"license": "3714",
"primary": false
},
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "ID",
"license": "O-0530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BCBS",
"identifier": "26705",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0731364",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CASI",
"last_name": "MCPHERSON",
"middle_name": "LYNN",
"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 Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.