NPIMap

Individual provider Active NPI

Robert Slade Thacker, APRN CFNP

  • Family Nurse Practitioner
  • Caldwell, ID
National Provider Identifier
1124309224
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-1096A Issued in ID
Practice address
712 Aviation Way
Caldwell, ID 83605-1154
Phone
(208) 302-7100
Fax
(208) 302-7155
NPI assigned
Sep 1, 2011
Last updated
Aug 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-1096A ID Primary

Addresses

Primary practice location

712 Aviation Way
Caldwell, ID 83605-1154

Mailing address

1906 Fairview Ave
Ste. 230
Caldwell, ID 83605-5407
Phone (208) 459-4667

Other practice location 1

1906 Fairview Ave
Ste. 230
Caldwell, ID 83605-5407
Phone (208) 459-4667

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ROBERT.THACKER@hca3.eclinicaldirectplus.com

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
I20120309000325 ID Practitioner - Nurse Practitioner 7517126659 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

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

3025 W Cherry LN
Meridian, ID 83642-8531

712 Aviation Way
Caldwell, ID 83605-1154
Phone (208) 302-1035

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP-1096AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 15, 2025 Accepting new patients
Carepoint Health Emergency Medicine Idaho, PLLC CurrentSince Jan 20, 2020 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 15, 2025 Accepting new patients
West Valley Medical Group Specialty Services LLC Past Accepting new patients
Idaho Emergency Physicians, P.a. PastSince Dec 1, 2011 Accepting new patients

Locations

1906 Fairview Ave
Ste 230
Caldwell, ID 83605
Phone (208) 795-5201

712 Aviation Way
Caldwell, ID 83605
Phone (208) 302-7100

1717 Arlington Ave
Caldwell, ID 83605
Phone (208) 455-3719

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

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

Interoperability endpoints

  • Direct secure messaging: robert.thacker@hca3.eclinicaldirectplus.com
  • Direct secure messaging: rthacker4649382@direct.trinity-health.org

Organizations & group practices 6

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 12

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": "1314835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1124309224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 FAIRVIEW AVE",
            "address_2": "STE. 230",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836055407",
            "telephone_number": "208-459-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 AVIATION WAY",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836051154",
            "telephone_number": "208-302-7100",
            "fax_number": "208-302-7155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Fairview Ave",
            "address_2": "STE. 230",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836055407",
            "country_code": "US",
            "telephone_number": "208-459-4667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THACKER",
        "first_name": "ROBERT",
        "middle_name": "SLADE",
        "credential": "APRN CFNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-01",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1096A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ROBERT.THACKER@hca3.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1906 Fairview Ave",
            "address_2": "STE. 230",
            "city": "Caldwell",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836055407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

Verify at the official NPI Registry.