Active NPI
Timothy P Hodges, DO. FAMILY PRACTICE
- Family Medicine Physician
- Boise, ID
National Provider Identifier
1225027253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0109
- Practice address
- 6052 W State St
Boise, ID 83703-2739 - Phone
- (208) 955-6500
- Fax
- (208) 955-6501
- NPI assigned
- Oct 21, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0109 | ID | Primary |
Addresses
Primary practice location
6052 W State St
Boise, ID 83703-2739
Mailing address
PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500
Other practice location 1
1648 NW 1st Street
Meridian, ID 83642
Phone (208) 888-9393
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295140648 | Medicaid | ID |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0109 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Idaho Department of Health and Welfare | 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.
-
- Clinic/Center
- Blackfoot, ID
- NPI 1538225545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703721600000",
"number": "1225027253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191050",
"city": "BOISE",
"state": "ID",
"postal_code": "837191050",
"telephone_number": "208-955-6500",
"fax_number": "208-955-6501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6052 W STATE ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837032739",
"telephone_number": "208-955-6500",
"fax_number": "208-955-6501"
}
],
"practiceLocations": [
{
"address_1": "1648 NW 1st Street",
"address_purpose": "LOCATION",
"city": "Meridian",
"state": "ID",
"postal_code": "83642",
"country_code": "US",
"telephone_number": "208-888-9393",
"fax_number": "208-888-9525",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HODGES",
"first_name": "TIMOTHY",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "DO. FAMILY PRACTICE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-21",
"last_updated": "2023-12-28",
"certification_date": "2023-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "0109",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295140648",
"state": "ID"
}
],
"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 Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.