Individual provider Active NPI

Annie Campbell, PA

  • Surgical Physician Assistant
  • Boise, ID
National Provider Identifier
1154414902
Registry record updated Sep 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
333 N 1St St
Suite 120
Boise, ID 83702-6100
Phone
(208) 381-7190
Fax
(208) 381-7191
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

333 N 1St St
Suite 120
Boise, ID 83702-6100

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-7190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050128000264 ID Practitioner - Physician Assistant 5193775013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
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)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

222 N 2ND St
Boise, ID 83702-6130

520 S Eagle Rd
Meridian, ID 83642-6351

520 S Eagle Rd
Meridian, ID 83642-6355

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

9580 W St Lukes Dr
Nampa, ID 83687-7912
Phone (208) 505-2711

9850 St Lukes Dr
Nampa, ID 83687-7912

9850 W St Luke'S Dr
Nampa, ID 83687-7912

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • St Luke'S Elmore Medical Center Hospital, Mountain Home, ID, CCN 131311

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Surgery CurrentSince May 1, 2012 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
#10
Boise, ID 83712

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

222 N 2nd St
Ste 215
Boise, ID 83702
Phone (208) 342-2706

300 E Jefferson St
Ste 300
Boise, ID 83712
Phone (208) 381-4100

520 S Eagle Rd
Ste 1201
Meridian, ID 83642
Phone (208) 706-5988

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

9850 W St Lukes Dr
Ste 215
Nampa, ID 83687
Phone (208) 489-1983

Interoperability endpoints

  • Direct secure messaging: acampbell15191@direct.slhs.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506470400000",
    "number": "1154414902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-7190",
            "fax_number": "208-381-7191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N 1ST ST",
            "address_2": "SUITE 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026100",
            "telephone_number": "208-381-7190",
            "fax_number": "208-381-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "ANNIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2017-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.