Boise Skin Clinic PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

M-9342 Issued in ID

Legal business name

BOISE SKIN CLINIC PLLC

Practice address

1636 S Hadley Ave
Boise, ID 83709-2684

Phone

(208) 209-7898

Fax

(208) 258-2079

NPI assigned

Oct 10, 2014

Last updated

Jan 22, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marnie R Ririe, MDNPI 1134170855

Title

Manager

Phone

(208) 258-2078

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Marnie R Ririe, MD

  • Dermatology Physician
  • Boise, ID
  • NPI 1134170855
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1104220797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1636 S HADLEY AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092684",
            "telephone_number": "208-209-7898",
            "fax_number": "208-258-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 S HADLEY AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092684",
            "telephone_number": "208-209-7898",
            "fax_number": "208-258-2079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE SKIN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "RIRIE",
        "authorized_official_first_name": "MARNIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-258-2078",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M-9342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134170855",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.