John R Sonntag, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

M4623 Issued in ID

Practice address

5680 W Gage St
Boise, ID 83706-1326

Phone

(208) 377-3937

Fax

(208) 377-9455

NPI assigned

Aug 29, 2005

Reactivated

Apr 10, 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Premier Surgical Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Boise, ID
  • NPI 1275516718
  NPD Authorized official

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

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1245223809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "280-377-3937",
            "fax_number": "208-377-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONNTAG",
        "first_name": "JOHN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-29",
        "last_updated": "2012-06-25",
        "deactivation_date": "2006-03-27",
        "reactivation_date": "2006-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M4623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001553800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Somsen
• Sonder Home Health Care, LLC
• Myung Ae Song, D.O. , M.B.A.
• Neeraj Soni, MD
• Richard Thomas Sonnenberg, PH.D.
• Paul David Sonntag, MD
• Sonshine Family Health Clinic, LLC
• Sontag Counseling PLLC
• Mary-Ann Sontag, PH.D. LCSW
• Albert Sorensen

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; 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.