Active NPI
Bradley Holbrook
- Maternal & Fetal Medicine Physician
- Boise, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Maternal & Fetal Medicine Physician
- License
- M-17863
- Practice address
- 333 N 1St St Ste 150
Boise, ID 83702-6135 - Phone
- (208) 381-3088
- Fax
- (208) 381-4314
- NPI assigned
- Apr 23, 2010
- Last updated
- Aug 1, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Maternal & Fetal Medicine Physician | 207VM0101X | MD2014-0229 | NM | |
| Maternal & Fetal Medicine Physician | 207VM0101X | M-17863 | ID | Primary |
Addresses
Primary practice location
333 N 1St St Ste 150
Boise, ID 83702-6135
Mailing address
190 E Bannock St Ste 2222
Boise, ID 83712-6241
Other practice location 1
2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone (505) 272-6225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT, ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- Eastern Virginia Medical School, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
333 N 1St St
Suite 150
Boise, ID 83702-6135
Phone (208) 381-7360
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-17863 | ID | MD | Maternal & Fetal Medicine Physician |
| MD2014-0229 | NM | MD | Maternal & Fetal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Current | Accepting new patients | |
| RCHP Billings - Missoula LLC | Current | Accepting new patients | |
| RCHP Billings - Missoula LLC | Current | Accepting new patients | |
| RCHP Billings - Missoula LLC | Current | Accepting new patients | |
| St Lukes Regional Medical Center | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
190 E Bannock St
Ste 2222
Boise, ID 83712
333 N 1st St
Ste 150
Boise, ID 83702
Phone (208) 381-3088
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
2230 N Reserve St
Missoula, MT 59808
Phone (406) 721-0533
2230 N Reserve St
Ste 402
Missoula, MT 59808
Phone (406) 327-3850
2827 Fort Missoula Rd
Missoula, MT 59804
Phone (406) 327-4202
Interoperability endpoints
- bholbrook@direct.communitymed.org
Organizations & group practices 5
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.
-
- Family Medicine Physician
- Boise, ID
- NPI 1326336058
-
dba Community Medical Center
- General Acute Care Hospital
- Missoula, MT
- NPI 1346642899
-
dba Community Physician Group
- Medical Oncology Physician
- Missoula, MT
- NPI 1891164125
-
dba St Lukes Meridian Medical Center
- General Acute Care Hospital
- Boise, ID
- NPI 1770586794
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba St Lukes Nampa Medical Center
- General Acute Care Hospital
- Nampa, ID
- NPI 1831590660
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1114244514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST STE 2222",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 N 1ST ST STE 150",
"city": "BOISE",
"state": "ID",
"postal_code": "837026135",
"telephone_number": "208-381-3088",
"fax_number": "208-381-4314"
}
],
"practiceLocations": [
{
"address_1": "2211 Lomas Blvd NE",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871062719",
"country_code": "US",
"telephone_number": "505-272-6225",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HOLBROOK",
"first_name": "BRADLEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-23",
"last_updated": "2024-08-01",
"certification_date": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "NM",
"license": "MD2014-0229",
"primary": false
},
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "ID",
"license": "M-17863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.