Active NPI
Wilbur Allen Rader, M.D.
- General Practice Physician
- Boise, ID
National Provider Identifier
1265452239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- M-7878
- Practice address
- 115 W Main St
Suite 101
Boise, ID 83702-7302 - Phone
- (208) 343-3652
- Fax
- (208) 367-9188
- NPI assigned
- Jul 20, 2006
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | M-7878 | ID | Primary |
Addresses
Primary practice location
115 W Main St
Suite 101
Boise, ID 83702-7302
Mailing address
115 W Main St
Suite 101
Boise, ID 83702-7302
Phone (208) 343-3652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 7, 2016 through Mar 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-7878 | ID | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185926400000",
"number": "1265452239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 W MAIN ST",
"address_2": "SUITE 101",
"city": "BOISE",
"state": "ID",
"postal_code": "837027302",
"telephone_number": "208-343-3652",
"fax_number": "208-367-9188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 W MAIN ST",
"address_2": "SUITE 101",
"city": "BOISE",
"state": "ID",
"postal_code": "837027302",
"telephone_number": "208-343-3652",
"fax_number": "208-367-9188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADER",
"first_name": "WILBUR",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "ID",
"license": "M-7878",
"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 Aug 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.