Individual provider Active NPI

Timothy A Bialobrzeski, D.O.

  • Pediatric Anesthesiology Physician
  • Boise, ID
National Provider Identifier
1104034438
Registry record updated Jul 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X
License
O-0626 Issued in ID
Practice address
338 E Bannock St
Boise, ID 83712-6207
Phone
(208) 336-0895
NPI assigned
May 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 936767 MI
Anesthesiology Physician 207L00000X O-0626 ID
Pediatric Anesthesiology Physician 207LP3000X O-0626 ID Primary

Addresses

Primary practice location

338 E Bannock St
Boise, ID 83712-6207

Mailing address

12661 N Schicks Ridge Rd
Boise, ID 83714-9456
Phone (208) 908-6224

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110825000225 ID Practitioner - Anesthesiology 8123298395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Boise, P.a.Group PAC ID 2668385287, 183 clinicians

Practice addresses (Care Compare)

338 E Bannock St
Boise, ID 83712-6207
Phone (208) 336-0895

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-0626IDMDAnesthesiology Physician
936767MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Boise, P.a. CurrentSince Jul 18, 2011 Accepting new patients

Locations

338 E Bannock St
Boise, ID 83712
Phone (208) 336-0895

2537 W State St
Ste 200
Boise, ID 83702
Phone (208) 336-0895

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1104034438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12661 N SCHICKS RIDGE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837149456",
            "telephone_number": "208-908-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126207",
            "telephone_number": "208-336-0895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIALOBRZESKI",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "936767",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "O-0626",
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "ID",
            "license": "O-0626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.