Active NPI
Linda Kaczmarek, DO
- Family Medicine Physician
- Nampa, ID
National Provider Identifier
1104896000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 51010162602
- Practice address
- 214 S Midland Blvd
Nampa, ID 83686-2602 - Phone
- (208) 465-6900
- Fax
- (208) 465-6911
- NPI assigned
- Jan 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 51010162602 | MI | Primary |
Addresses
Primary practice location
214 S Midland Blvd
Nampa, ID 83686-2602
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4767365 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51010162602 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360281600000",
"number": "1104896000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421026",
"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": "214 S MIDLAND BLVD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836862602",
"telephone_number": "208-465-6900",
"fax_number": "208-465-6911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACZMAREK",
"first_name": "LINDA",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-24",
"last_updated": "2013-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "51010162602",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4767365",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.