Individual provider Active NPI

Ike D Tanabe, M.D.

  • Gastroenterology Physician
  • Boise, ID
National Provider Identifier
1184691602
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
M5803 Issued in ID
Practice address
6259 W Emerald St
Boise, ID 83704-8731
Phone
(208) 489-1900
Fax
(208) 375-5286
NPI assigned
Mar 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X M5803 ID Primary

Addresses

Primary practice location

6259 W Emerald St
Boise, ID 83704-8731

Mailing address

6259 W Emerald St
Boise, ID 83704-8731
Phone (208) 489-1900

Other identifiers 1

IdentifierTypeStateIssuer
003976400MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, HI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070309000544 ID Practitioner - GastroenterologyPractitioner - Internal Medicine 9931100492 Reassigns benefits to 1 organization
I20130123000381 HI Practitioner - Gastroenterology 9931100492 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Washington School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Health Clinic LLCGroup PAC ID 7315948874, 26 clinicians
Straub Clinic and HospitalGroup PAC ID 6305759754, 420 clinicians

Practice addresses (Care Compare)

6259 W Emerald St
Boise, ID 83704-8731
Phone (208) 489-1900

888 S King St
Honolulu, HI 96813-3097
Phone (808) 522-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy154
Upper gastrointestinal (GI) endoscopy for acid reflux131

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M5803IDMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Endoscopy Center LLC Current Accepting new patients
Straub Clinic & Hospital CurrentSince Jan 7, 2013 Accepting new patients
Straub Clinic & Hospital CurrentSince Jan 7, 2013 Accepting new patients
Straub Clinic & Hospital Past Accepting new patients

Locations

888 S King St
Honolulu, HI 96813
Phone (808) 522-4000

6259 W Emerald St
Boise, ID 83704
Phone (208) 489-1900

5080 E Commerce St
Nampa, ID 83687
Phone (208) 489-1900

Networks

  • HI PPO
  • devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

Organizations & group practices 5

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 2

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": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1184691602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6259 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048731",
            "telephone_number": "208-489-1900",
            "fax_number": "208-375-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6259 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048731",
            "telephone_number": "208-489-1900",
            "fax_number": "208-375-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANABE",
        "first_name": "IKE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ID",
            "license": "M5803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003976400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.