Bryan Reed Medaris, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3814 Issued in ID

Practice address

4411 E Flamingo Ave
Nampa, ID 83687-3113

Phone

(208) 466-3597

Fax

(208) 466-8147

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174673222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12231 W CARIBEE INLET DR",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695653",
            "telephone_number": "208-286-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 E FLAMINGO AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836873113",
            "telephone_number": "208-466-3597",
            "fax_number": "208-466-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDARIS",
        "first_name": "BRYAN",
        "middle_name": "REED",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly June McOmber, LPC
• Ryley McPeters, M.D.
• Ryan H Mecham, MD
• Sydney Mecham, AUD
• Med Lift LLC
• Medical Associates of Idaho, LLC
• Medical Directors of Idaho PLLC
• Juan Miguel Medina Araujo
• Mednow, Inc
• Mednow, Inc

• General Practice Dentistry in Nampa, ID
• Providers in Nampa, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.