Ronnie Bryon Isaacson, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-1707 Issued in ID

Practice address

4615 W Emerald St
Boise, ID 83706-2002

Phone

(208) 917-1842

NPI assigned

Jan 15, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Numinus Wellness Ut IncGroup PAC ID 2163750688, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ronnie.isaacson.1@17324.direct.athenahealth.com

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.

• Numinus Wellness Ut Inc

  • Psychiatry Physician
  • Springville, UT
  • NPI 1265092282
  Medicare reassignment Care Compare group
• Ogden Internal Medicine & Urology LLC

  • Internal Medicine Physician
  • Ogden, UT
  • NPI 1003001553

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1275007965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13825 PARAISO ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836078088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4615 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062002",
            "telephone_number": "208-917-1842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "331 SE 2nd St",
            "address_purpose": "LOCATION",
            "city": "Pendleton",
            "state": "OR",
            "postal_code": "978012224",
            "country_code": "US",
            "telephone_number": "541-276-6207",
            "fax_number": "541-276-4628",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "595 NW 11th St",
            "address_purpose": "LOCATION",
            "city": "Hermiston",
            "state": "OR",
            "postal_code": "978386600",
            "country_code": "US",
            "telephone_number": "541-567-2536",
            "fax_number": "541-567-2362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "702 Sunset Dr",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "OR",
            "postal_code": "979143121",
            "country_code": "US",
            "telephone_number": "541-889-9167",
            "fax_number": "541-889-7873",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1044 Northwest Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142114",
            "country_code": "US",
            "telephone_number": "208-917-1842",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1019 W Sanetta St",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836515047",
            "country_code": "US",
            "telephone_number": "208-917-1842",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2609 S 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836056816",
            "country_code": "US",
            "telephone_number": "208-841-3020",
            "fax_number": "208-549-7017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISAACSON",
        "first_name": "RONNIE",
        "middle_name": "BRYON",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-15",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA191453",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Matthews Irwin, MD
• Christine Dee Isaacs, PHD
• Heidi Isaacs
• Kimberly Isaacs, PHARMD
• Lindy Isaacson, LM, CPM
• Jessica Renee Isaak, LMSW
• Levania Habonimana Isack
• Isara Group Inc.
• Aimee Ishimwe
• Flora Ishimwe

• Medical Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.