NPIMap

Individual provider Active NPI

Shahla Walizada, DO

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1205272986
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O0953 Issued in ID
Practice address
2141 E Parkcenter Blvd
Samg BHP Family Medicine
Boise, ID 83706
Phone
(208) 302-5000
Fax
(208) 302-5025
NPI assigned
May 21, 2013
Last updated
Oct 20, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O0953 ID Primary

Addresses

Primary practice location

2141 E Parkcenter Blvd
Samg BHP Family Medicine
Boise, ID 83706

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 302-5000

Other names 1

  • Shahla Noori Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160809002452 ID Practitioner - Family Practice 7315231693 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Pacific Medical College, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2141 E Parkcenter Blvd
Boise, ID 83706-6701
Phone (208) 302-5000

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O0953IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2016 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2016 Accepting new patients

Locations

2141 E Parkcenter Blvd
Boise, ID 83706
Phone (208) 302-5000

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: swalizada150417@direct.trinity-health.org

Organizations & group practices 3

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 7

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": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1205272986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-5000",
            "fax_number": "208-302-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 E PARKCENTER BLVD",
            "address_2": "SAMG BHP FAMILY MEDICINE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83706",
            "telephone_number": "208-302-5000",
            "fax_number": "208-302-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALIZADA",
        "first_name": "SHAHLA",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-21",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O0953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAHLA",
            "last_name": "NOORI",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.