Individual provider Active NPI

Bradley Holbrook

  • Maternal & Fetal Medicine Physician
  • Boise, ID
National Provider Identifier
1114244514
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
License
M-17863 Issued in ID
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, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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, ID2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170807003644 MT Practitioner - Obstetrics/Gynecology 8820218951 Reassigns benefits to 1 organization
I20241007003381 ID Practitioner - Obstetrics/Gynecology 8820218951 Reassigns benefits to 1 organization

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
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

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

LicenseStateTypeSpecialty
M-17863IDMDMaternal & Fetal Medicine Physician
MD2014-0229NMMDMaternal & Fetal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Aug 1, 2024 Accepting new patients
RCHP Billings - Missoula LLC Current Accepting new patients
RCHP Billings - Missoula LLC Current Accepting new patients
RCHP Billings - Missoula LLC CurrentSince Aug 1, 2017 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 1

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": "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

Verify at the official NPI Registry.