Active NPI
Cassi Mendiola Watkins, R.D., L.D.
- Registered Dietitian
- Boise, ID
National Provider Identifier
1215369293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86013281
- Practice address
- 100 E Idaho St
Boise, ID 83712-6267 - Phone
- (208) 381-4011
- NPI assigned
- Aug 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86013281 | ID | Primary |
Addresses
Primary practice location
100 E Idaho St
Boise, ID 83712-6267
Mailing address
100 E Idaho St
Boise, ID 83712-6267
Phone (208) 381-4011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86013281 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1215369293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E IDAHO ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126267",
"telephone_number": "208-381-4011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E IDAHO ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126267",
"telephone_number": "208-381-4011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATKINS",
"first_name": "CASSI",
"middle_name": "MENDIOLA",
"name_prefix": "Mrs.",
"credential": "R.D., L.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-01",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "86013281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.