Carl Ryan Andrus, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-508 Issued in ID

Practice address

4902 W State St
Boise, ID 83703-3326

Phone

(208) 853-3100

Fax

(208) 853-3120

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Cornerstone Orthopaedic Trauma Associates

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1245979491
  NPD (past)
• Physicians Clinic PLLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1992895866
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215949532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4902 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033326",
            "telephone_number": "208-853-3100",
            "fax_number": "208-853-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4902 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033326",
            "telephone_number": "208-853-3100",
            "fax_number": "208-853-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRUS",
        "first_name": "CARL",
        "middle_name": "RYAN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000010157032",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807520000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAD25",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010157033",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAD26",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Andrews
• Ofelia Z Andrews, LPC
• Sara Andrews
• Susan Andrews
• Karina Andrewson, FNP-C
• Julianne Maria Andrysiak, LCSW
• Alyse Michelle Anekstein
• Anesthesia Associates of Boise, P.a.
• Anesthesiology Consultants of Treasure Valley PLLC
• Angel Home Care Services, LLC

• All providers in Boise, ID
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.