Nicholas W. Hodgman, MD
Individual provider Active NPI Interventional Cardiology Physician · Nampa, ID
NPI 1164439725 · NPPES record last updated Jul 23, 2019
Key facts
- NPI
- 1164439725
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Interventional Cardiology Physician 207RI0011X
- License
- M-14705 (ID)
- Practice address
- 4424 E Flamingo Ave
Ste 300
Nampa, ID 83687 - Phone
- (208) 302-0200
- Fax
- (208) 302-0255
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Interventional Cardiology
- Education
- Medical College of Wisconsin, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Alphonsus Regional Medical Center Inc
Practice addresses (Care Compare)
1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121
3025 W Cherry LN
Meridian, ID 83642-8531
3175 Pocahontas Rd
Baker City, OR 97814-1434
Phone (208) 302-2200
323 E Riverside Dr
Suite 224
Eagle, ID 83616-6865
Phone (208) 302-6000
3325 Pocahontas Rd
Baker City, OR 97814-1464
Phone (541) 523-6461
351 SW 9TH St
Ontario, OR 97914-2639
Phone (541) 881-7000
402 Lake Cascade Pkwy
Cascade, ID 83611-7702
Phone (208) 302-0000
4300 E Flamingo Ave
Nampa, ID 83687-3138
Phone (208) 205-1000
4424 E Flamingo Ave
Nampa, ID 83687-9306
6140 W Curtisian Ave
Boise, ID 83704-0107
Phone (208) 302-0000
6140 W Curtisian Ave
Boise, ID 83704-0109
Hospital & facility affiliations
- Saint Alphonsus Medical Center - Nampa
- Saint Alphonsus Regional Medical Center
- Saint Alphonsus Medical Center Ontario
- St. Alphonsus Medical Center - Baker City
- St Luke'S Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID, OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190912001093 | ID | Practitioner - Interventional Cardiology | 1153472006 | Reassigns benefits to 2 organizations |
| I20200212000875 | OR | Practitioner - Interventional Cardiology | 1153472006 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38352 | IA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Alphonsus Medical Center Nampa, Inc. | Current |
Accepting new patients | |
| Saint Alphonsus Regional Medical Center Inc | Cardiovascular Disease | Current |
Accepting new patients |
| Saint Alphonsus Regional Medical Center Inc | Cardiovascular Disease | Current | Accepting new patients |
| Saint Alphonsus Regional Medical Center Inc | Current |
Accepting new patients | |
| Saint Alphonsus Specialty Services Inc | Cardiovascular Disease | Current |
Accepting new patients |
| Trinity Regional Medical Center | Past | Accepting new patients | |
| Saint Alphonsus Medical Center- Ontario Inc | Past | Accepting new patients |
Locations
1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152
323 E Riverside Dr
Ste 224
Eagle, ID 83616
Phone (208) 302-6000
3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342
3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400
3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400
4400 E Flamingo Ave
Ste 100
Nampa, ID 83687
Phone (208) 302-2200
4424 E Flamingo Ave
Ste 300
Nampa, ID 83687
Phone (208) 302-0200
3175 Pocahontas Rd
Baker City, OR 97814
Phone (208) 302-2200
1050 SW 3rd Ave
Ste 1800
Ontario, OR 97914
1050 SW 3rd Ave
Ontario, OR 97914
Phone (541) 881-7000
Interoperability endpoints
- nhodgman1563994@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 38352 | IA | |
| Interventional Cardiology Physician | 207RI0011X | M-14705 | ID | Yes |
Addresses
Primary practice location
4424 E Flamingo Ave
Ste 300
Nampa, ID 83687
Mailing address
3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-0200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CA3899 | Other | RR MEDICARE GROUP | |
| POO731202 | Other | RR MEDICARE INDIV | |
| 71960 | Other | MEDICARE GROUP |
Other providers in Nampa, ID
- Hills Behavioral Health Services LLC
- Hills Behavioral Health Services LLC
- Patrice Ferron Hirning
- Aaron Hoblet
- Michelle Ann Hocker
- Bonnie Hoewing
- Kathy Lynn Hohenbrink
- Shauni Holcomb
- Holistic Healthcare LLC.
- Keith G Holley
All providers in Nampa, ID · Interventional Cardiology Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.