Active NPI
Cyndy Eldredge Radovich, MMA
- Behavior Technician
- Meridian, ID
National Provider Identifier
1255983003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 917 N Main St
Meridian, ID 83642-2301 - Phone
- (208) 409-1785
- NPI assigned
- Jul 11, 2019
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
917 N Main St
Meridian, ID 83642-2301
Mailing address
8008 W Wesley Dr
Boise, ID 83704-7160
Phone (208) 409-1785
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A0002769 | 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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1255983003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8008 W WESLEY DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837047160",
"telephone_number": "208-409-1785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 N MAIN ST",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836422301",
"telephone_number": "208-409-1785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADOVICH",
"first_name": "CYNDY",
"middle_name": "ELDREDGE",
"name_prefix": "Mrs.",
"credential": "MMA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-11",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A0002769",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.