Shana L Tubach, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-8077 Issued in ID

Practice address

1072 N Liberty St
Suite 203
Boise, ID 83704-8708

Phone

(208) 302-5800

Fax

(208) 302-5855

NPI assigned

Jun 14, 2006

Last updated

Nov 10, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stubach1564470@direct.trinity-health.org

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.

• Saint Alphonsus Regional Medical Center Inc

  • Psychologist
  • Boise, ID
  • NPI 1649357716
  Medicare reassignment NPD
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  NPD
• Saint Alphonsus Regional Medical Center Inc

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1861676298

  Pediatrics

  NPD
• Saint Alphonsus Physician Services Inc

  dba Saint Alphonsus Medical Group Elm

  • Rural Health Clinic/Center
  • Caldwell, ID
  • NPI 1578767117
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1205879483",
    "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": "208-302-5800",
            "fax_number": "208-302-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 N LIBERTY ST",
            "address_2": "SUITE 203",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048708",
            "telephone_number": "208-302-5800",
            "fax_number": "208-302-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBACH",
        "first_name": "SHANA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M8077",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-8077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805784500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanner Trumble
• Alexandra Tsai, MS, LCGC
• Vitaliy Tsema
• Gregory Tsuda
• Martin R Tubach, MD
• Gary Arthur Tubbs, M.D.
• Clay S Tuck, LMSW
• Wavey Louise Tuck, LCSW
• Kendal Michelle Tucker, LPC
• Kerri L Tucker, NP

• Pediatrics Physician in Boise, ID
• Providers in Boise, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.