Active NPI
Matthew Robert Sara, M.D.
- Family Medicine Physician
- Meridian, ID
National Provider Identifier
1275979346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M-15202
- Practice address
- 1648 NW 1St St
Meridian, ID 83642-2212 - Phone
- (208) 888-9393
- NPI assigned
- May 16, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18456 | FL | |
| Family Medicine Physician | 207Q00000X | M-15202 | ID | Primary |
Addresses
Primary practice location
1648 NW 1St St
Meridian, ID 83642-2212
Mailing address
PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18456 | FL | MD | Family Medicine Physician |
| M-15202 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597017600000",
"number": "1275979346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191050",
"city": "BOISE",
"state": "ID",
"postal_code": "837191050",
"telephone_number": "208-955-6500",
"fax_number": "208-955-6503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1648 NW 1ST ST",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836422212",
"telephone_number": "208-888-9393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SARA",
"first_name": "MATTHEW",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-16",
"last_updated": "2020-08-10",
"certification_date": "2020-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "18456",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M-15202",
"primary": true
}
],
"identifiers": [],
"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 Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.