NPIMap

Individual provider Active NPI

Kenneth Madsen, MD

  • Vascular Surgery Physician
  • Boise, ID
National Provider Identifier
1164412862
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
M-12372 Issued in ID
Practice address
1075 N Curtis Rd Ste 101
Boise, ID 83706-1348
Phone
(208) 302-2800
Fax
(208) 302-2825
NPI assigned
Oct 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 6720A WY
Surgery Physician 208600000X 2018-01195 NC
Vascular Surgery Physician 2086S0129X 6720A WY
Vascular Surgery Physician 2086S0129X M-12372 ID Primary
Vascular Surgery Physician 2086S0129X ME153722 FL

Addresses

Primary practice location

1075 N Curtis Rd Ste 101
Boise, ID 83706-1348

Mailing address

3810 Northdale Blvd
Ste 150
Tampa, FL 33624-1871

Other practice location 1

208 Cox Blvd Ste 201
Goldsboro, NC 27534-9414
Phone (919) 587-3333

Other identifiers 2

IdentifierTypeStateIssuer
01371657MedicaidCO
121692900MedicaidWY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmadsen437492@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141222000409 CO Practitioner - Vascular SurgeryPractitioner - General Surgery 2769402403
I20231120002255 ID Practitioner - Vascular Surgery 2769402403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
George Washington University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

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

1075 N Curtis Rd
Boise, ID 83706-1348

1075 N Curtis Rd
Boise, ID 83706-1350
Phone (208) 302-2000

3025 W Cherry LN
Meridian, ID 83642-8531

4300 E Flamingo Ave
Nampa, ID 83687-3138
Phone (208) 205-1000

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013
  • Grande Ronde Hospital Hospital, La Grande, OR, CCN 381321

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Varicose vein removal20
Leg revascularization (restoring blood flow)39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2018-00195NCMDAnesthesiology Physician
2018-01195NCMDSurgery Physician
ME153722FLMDVascular Surgery Physician
M-12372IDMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Nov 1, 2023 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Nov 1, 2023 Accepting new patients
Colorado Medical Group, PLLC Surgery PastSince Jun 1, 2023 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

1075 N Curtis Rd
Ste 101
Boise, ID 83706
Phone (208) 302-2800

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: kmadsen437492@direct.unc.nchie.net
  • Direct secure messaging: kmadsen2940590@direct.trinity-health.org

Organizations & group practices 4

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 11

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": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1164412862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 NORTHDALE BLVD",
            "address_2": "STE 150",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N CURTIS RD STE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061348",
            "telephone_number": "208-302-2800",
            "fax_number": "208-302-2825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Cox Blvd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Goldsboro",
            "state": "NC",
            "postal_code": "275349414",
            "country_code": "US",
            "telephone_number": "919-587-3333",
            "fax_number": "919-587-3334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADSEN",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WY",
            "license": "6720A",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2018-01195",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WY",
            "license": "6720A",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ID",
            "license": "M-12372",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME153722",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01371657",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121692900",
            "state": "WY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmadsen437492@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "208 Cox Blvd Ste 201",
            "city": "Goldsboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275349414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.