NPIMap

Organization Active NPI

St Luke'S Humphreys Diabetes Center Inc

  • Registered Dietitian
  • Boise, ID
National Provider Identifier
1306984729
Registry record updated Jul 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
ST LUKE'S HUMPHREYS DIABETES CENTER INC
Practice address
1226 W River St
Boise, ID 83702-7049
Phone
(208) 331-1155
Fax
(208) 383-0190
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2011

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

Authorized official

Name
Mr. Robert Scanlon
Title
Executive Director
Phone
(208) 331-1155

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X 4366980001 ID

Addresses

Primary practice location

1226 W River St
Boise, ID 83702-7049

Mailing address

1226 W River St
Boise, ID 83702-7049
Phone (208) 331-1155

Other identifiers 5

IdentifierTypeStateIssuer
000010170136OtherIDREGENCE WALTERS
807850000MedicaidID
806348400MedicaidID
8G502OtherIDBLUE CROSS
000010013347OtherIDBLUE SHIELD

Other names 1

  • Humphreys Diabetes Center INC Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311811200000",
    "number": "1306984729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-331-1155",
            "fax_number": "208-383-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-331-1155",
            "fax_number": "208-383-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S HUMPHREYS DIABETES CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2011-07-28",
        "status": "A",
        "authorized_official_last_name": "SCANLON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-331-1155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "4366980001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE WALTERS",
            "identifier": "000010170136",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807850000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806348400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8G502",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010013347",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humphreys Diabetes Center INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jul 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.