NPIMap

Individual provider Active NPI

Ethan Alexander Taub, D.O.

  • Surgery Physician
  • Boise, ID
National Provider Identifier
1295002285
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4061377 Issued in ID
Practice address
999 N Curtis Rd Ste 415
Boise, ID 83706-1334
Phone
(208) 302-2600
Fax
(208) 302-2625
NPI assigned
Nov 19, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X P5741 TX
Surgery Physician 208600000X P5741 TX
Surgery Physician 208600000X 036137282 IL
Surgery Physician 208600000X 4061377 ID Primary

Addresses

Primary practice location

999 N Curtis Rd Ste 415
Boise, ID 83706-1334

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

6431 Fannin St
MSB 4.284, Department Of Surgery
Houston, TX 77030-1501
Phone (713) 500-7244

Other identifiers 1

IdentifierTypeStateIssuer
320190706MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240910001370 ID Practitioner - Critical Care (Intensivists) 5597905455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St. Alphonsus Medical Center - Baker City Hospital, Baker City, OR, CCN 381315
  • North Canyon Medical Center Hospital, Gooding, ID, CCN 131302
  • Weiser Memorial Hospital Hospital, Weiser, ID, CCN 131307

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2024 Accepting new patients
Saint Alphonsus Specialty Services Inc Surgery PastSince Aug 18, 2024 Accepting new patients

Locations

999 N Curtis Rd
Ste 415
Boise, ID 83706
Phone (208) 302-2600

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: etaub3502631@direct.trinity-health.org
  • Direct secure messaging: etaub86118@utmdandersoncc.direct-ci.com
  • Direct secure messaging: etaub11986@direct.uth.org

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1321660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1295002285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N CURTIS RD STE 415",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061334",
            "telephone_number": "208-302-2600",
            "fax_number": "208-302-2625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6431 Fannin St",
            "address_2": "MSB 4.284, Department Of Surgery",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301501",
            "country_code": "US",
            "telephone_number": "713-500-7244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAUB",
        "first_name": "ETHAN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-19",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "P5741",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "P5741",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036137282",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "4061377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320190706",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.