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Individual provider Active NPI

Cassie Nicole Wilson, AGCANP

  • Nurse Practitioner
  • Boise, ID
National Provider Identifier
1104573112
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
66379 Issued in ID
Practice address
1075 N Curtis Rd Ste 101
Boise, ID 83706-1348
Phone
(208) 302-2800
Fax
(208) 302-2825
NPI assigned
Mar 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 66379 ID Primary

Addresses

Primary practice location

1075 N Curtis Rd Ste 101
Boise, ID 83706-1348

Mailing address

PO Box 31001-2360
Pasadena, CA 91110-2360
Phone (208) 367-5170

Other practice location 1

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

Other names 1

  • Cassie Nicole Street Former name

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
I20220418001162 ID Practitioner - Nurse Practitioner 7911394127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

1075 N Curtis Rd
Boise, ID 83706-1348

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St. Alphonsus Medical Center - Baker City Hospital, Baker City, OR, CCN 381315
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
66379IDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jun 1, 2022 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Nurse Practitioner CurrentSince Jun 1, 2022 Accepting new patients

Locations

1075 N Curtis Rd
Ste 101
Boise, ID 83706
Phone (208) 302-2800

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

Interoperability endpoints

  • Direct secure messaging: cstreet1585959@direct.trinity-health.org

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1104573112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-2360",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911102360",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N CURTIS RD STE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061348",
            "telephone_number": "208-302-2800",
            "fax_number": "208-302-2825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 N Curtis Rd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837061309",
            "country_code": "US",
            "telephone_number": "208-367-2121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CASSIE",
        "middle_name": "NICOLE",
        "credential": "AGCANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-09",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "66379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CASSIE",
            "last_name": "STREET",
            "middle_name": "NICOLE",
            "credential": "AGCANP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.