NPIMap

Individual provider Active NPI

Kimereng Kipchumba Kipsuge, NP

  • Acute Care Nurse Practitioner
  • Boise, ID
National Provider Identifier
1205489978
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
62135 Issued in ID
Practice address
1883 Wildwood St Ste C
Boise, ID 83713-5146
Phone
(208) 901-7006
NPI assigned
Jul 22, 2019
Last updated
Jun 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 62135 ID Primary

Addresses

Primary practice location

1883 Wildwood St Ste C
Boise, ID 83713-5146

Mailing address

1883 Wildwood St Ste C
Boise, ID 83713-5146
Phone (208) 901-7006

Other names 1

  • Kimereng Kipchumba Kipsuge Professional 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
I20200303000868 ID Practitioner - Nurse Practitioner 5092142109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clair Specialty Physicians PCGroup PAC ID 6204733256, 36 clinicians

Practice addresses (Care Compare)

5610 W Gage St
Suite a
Boise, ID 83706-1332
Phone (208) 367-3370

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62135IDMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Specialty Physicians PC CurrentSince Feb 17, 2022 Accepting new patients

Locations

5610 W Gage St
Ste A
Boise, ID 83706
Phone (208) 367-3370

1818 S 10th Ave
Ste 120
Caldwell, ID 83605
Phone (208) 468-5959

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

840 N 4th E
Mountain Home, ID 83647
Phone (208) 587-1850

45640 Schoenherr Rd
Utica, MI 48315
Phone (586) 247-4300

Interoperability endpoints

  • Direct secure messaging: kimerengkipsuge@stclairspe.allscriptsdirect.net

Organizations & group practices 1

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 11

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": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1205489978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1883 WILDWOOD ST STE C",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837135146",
            "telephone_number": "208-901-7006",
            "fax_number": "949-561-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1883 WILDWOOD ST STE C",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837135146",
            "telephone_number": "208-901-7006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIPSUGE",
        "first_name": "KIMERENG",
        "middle_name": "KIPCHUMBA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-22",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "ID",
            "license": "62135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMERENG",
            "last_name": "KIPSUGE",
            "middle_name": "KIPCHUMBA",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.