Individual provider Active NPI

Meghann R Bostrom, NP-C

  • Nurse Practitioner
  • Boise, ID
National Provider Identifier
1174839666
Registry record updated Dec 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP-1001A Issued in ID
Practice address
13099 W Paint Dr
Boise, ID 83713-1927
Phone
(208) 724-2599
NPI assigned
Aug 23, 2010
Last updated
Dec 27, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP-1001A ID Primary

Addresses

Primary practice location

13099 W Paint Dr
Boise, ID 83713-1927

Mailing address

190 E Bannock St
Boise, ID 83712-6241

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
I20120607000610 ID Practitioner - Nurse Practitioner 4880858646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
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)

3525 E Louise Dr
Meridian, ID 83642-6303

3525 E Louise Dr
Meridian, ID 83642-6305

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jun 12, 2012 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

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

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

3525 E Louise Dr
Ste 401
Meridian, ID 83642

3525 E Louise Dr
Ste 500
Meridian, ID 83642
Phone (208) 706-7050

Interoperability endpoints

  • Direct secure messaging: mbostrom13759@direct.slhs.org

Organizations & group practices 2

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

Hospital & facility affiliations 3

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": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356566400000",
    "number": "1174839666",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13099 W PAINT DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131927",
            "telephone_number": "208-724-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTROM",
        "first_name": "MEGHANN",
        "middle_name": "R",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2012-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP-1001A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.