NPIMap

Individual provider Active NPI

Theresa Xuan Pham, MD

  • Diagnostic Radiology Physician
  • Durham, NC
National Provider Identifier
1093212003
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2023-00041 Issued in NC
Practice address
2301 Erwin Rd
Durham, NC 27705-4699
Phone
(919) 684-8111
NPI assigned
Apr 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2023-00041 NC Primary
Diagnostic Radiology Physician 2085R0202X 11414332-1205 UT
Internal Medicine Physician 207R00000X 1093212003 ID

Addresses

Primary practice location

2301 Erwin Rd
Durham, NC 27705-4699

Mailing address

PO Box 1616
Evansville, IN 47706-0018
Phone (844) 825-9300

Other practice location 1

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2094

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240731004269 ID Practitioner - Diagnostic Radiology 9133474067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Utah School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boise Radiology Group PLLCGroup PAC ID 9638153257, 64 clinicians

Practice addresses (Care Compare)

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2094

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1093212003IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System Inc Diagnostic Radiology CurrentSince Aug 1, 2023 Accepting new patients
Boise Radiology Group PLLC Diagnostic Radiology CurrentSince Aug 1, 2024 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

100 E Idaho St
Boise, ID 83712
Phone (208) 343-3223

3140 W Milano Dr
Ste 150
Meridian, ID 83646
Phone (208) 887-4775

85 S Middleton Rd
Nampa, ID 83651
Phone (208) 381-4100

Interoperability endpoints

  • Direct secure messaging: tpham548118@direct.medicine.duke.edu

Organizations & group practices 2

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 11

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": "1523059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1093212003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1616",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477060018",
            "telephone_number": "844-825-9300",
            "fax_number": "541-758-3713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 E Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83712",
            "country_code": "US",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "THERESA",
        "middle_name": "XUAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-07",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2023-00041",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "11414332-1205",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "1093212003",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.