Individual provider Active NPI

Shaylan Pease, PA-C

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1275936981
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1509 Issued in ID
Practice address
6052 W State St
Boise, ID 83703-2739
Phone
(208) 344-7799
Fax
(208) 322-8095
NPI assigned
Oct 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1509 ID Primary

Addresses

Primary practice location

6052 W State St
Boise, ID 83703-2739

Mailing address

9155 SW Barnes Rd
Suite 210
Portland, OR 97225-6625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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

Enrollment IDStateProvider typePAC IDDetails
I20171128001021 ID Practitioner - Physician Assistant 0749508513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians

Practice addresses (Care Compare)

10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500

11197 W Fairview Ave
Boise, ID 83713-7935
Phone (208) 378-8011

1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860

4971 W Overland Rd
Boise, ID 83705-2822
Phone (208) 472-5050

512 N 21St Ave
Caldwell, ID 83605-4368
Phone (208) 809-2875

6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947

8971 W Overland Rd
Boise, ID 83709-1651
Phone (208) 378-4288

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC CurrentSince Jun 9, 2025 Accepting new patients
Alliance Medical Group, LLC Past Accepting new patients

Locations

6052 W State St
Boise, ID 83703
Phone (208) 344-7799

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

Interoperability endpoints

  • Direct secure messaging: shaylan.pease@phmg.eclinicaldirectplus.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1275936981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "address_2": "SUITE 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625"
        },
        {
            "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": "208-344-7799",
            "fax_number": "208-322-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEASE",
        "first_name": "SHAYLAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-08",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.