NPIMap

Organization Active NPI

St Michael Nephrology, PLLC

Doing business as St Mikes Neph

  • Nephrology Physician
  • Boise, ID
National Provider Identifier
1144887050
Registry record updated Jul 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
ST MICHAEL NEPHROLOGY, PLLC
Doing business as
St Mikes Neph
Practice address
1674 S Loggers Pond PL Apt 14
Boise, ID 83706-7517
Phone
(986) 200-8202
Fax
(626) 593-4751
NPI assigned
May 26, 2019
Last updated
Jul 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2019

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

Authorized official

Name
Dr. Ernest Daniel Moreno Dytiapco, MDNPI 1255629846
Title
Nephrologist
Phone
(986) 200-8202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

1674 S Loggers Pond PL Apt 14
Boise, ID 83706-7517

Mailing address

999 W Main St Ste 100
Boise, ID 83702-9001

Other practice location 1

190 E Bannock St
Boise, ID 83712
Phone (986) 200-8202

Other names 1

  • St Mikes Neph Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563062400000",
    "number": "1144887050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 W MAIN ST STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837029001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1674 S LOGGERS POND PL APT 14",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837067517",
            "telephone_number": "986-200-8202",
            "fax_number": "626-593-4751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 E Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83712",
            "country_code": "US",
            "telephone_number": "986-200-8202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST MICHAEL NEPHROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-26",
        "last_updated": "2019-07-14",
        "status": "A",
        "authorized_official_last_name": "DYTIAPCO",
        "authorized_official_first_name": "ERNEST DANIEL",
        "authorized_official_middle_name": "MORENO",
        "authorized_official_title_or_position": "NEPHROLOGIST",
        "authorized_official_telephone_number": "986-200-8202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Mikes Neph",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Mikes Neph",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.