Active NPI
J. Michael Dennis, PHD
- Psychologist
- Boise, ID
National Provider Identifier
1326084492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY371
- Practice address
- 311 N. Allumbaugh St.
Boise, ID 83704 - Phone
- (208) 375-6402
- Fax
- (208) 323-1850
- NPI assigned
- Jun 20, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY371 | ID | Primary |
Addresses
Primary practice location
311 N. Allumbaugh St.
Boise, ID 83704
Mailing address
311 N. Allumbaugh St.
Boise, ID 83704
Phone (208) 375-6402
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010008943 | Other | REGENCE BLUE SHIELD | |
| N4809 | Other | ID | BLUE CROSS OF IDAHO |
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY371 | ID | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195171200000",
"number": "1326084492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 N. ALLUMBAUGH ST.",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-375-6402",
"fax_number": "208-323-1850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 N. ALLUMBAUGH ST.",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-375-6402",
"fax_number": "208-323-1850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNIS",
"first_name": "J. MICHAEL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2007-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ID",
"license": "PSY371",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010008943",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "N4809",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}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 Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.