Active NPI
Justin Bruner, D.O.
- Obstetrics & Gynecology Physician
- Nampa, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 34.014376
- Practice address
- 9850 W St Lukes Dr
Nampa, ID 83687-7912 - Phone
- (208) 381-2267
- NPI assigned
- Feb 20, 2013
- Last updated
- Jun 1, 2023
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | OP60746570 | WA | |
| Obstetrics & Gynecology Physician | 207V00000X | 5101020304 | MI | |
| Obstetrics & Gynecology Physician | 207V00000X | O-1792 | ID | |
| Obstetrics & Gynecology Physician | 207V00000X | 34.014376 | OH | Primary |
Addresses
Primary practice location
9850 W St Lukes Dr
Nampa, ID 83687-7912
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Other practice location 1
112 N Ewing St
Lancaster, OH 43130-3307
Phone (740) 689-6690
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 87.3 of 100
- Quality
- 81.29
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.37
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O-1792 | ID | MD | Obstetrics & Gynecology Physician |
| 5101020304 | MI | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Obstetrics & Gynecology | Current | Accepting new patients |
| St Lukes Clinic-Treasure Valley LLC | Current | Accepting new patients | |
| St Lukes Regional Medical Center | Past | Accepting new patients | |
| St Lukes West LTD | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
9850 W St Lukes Dr
Nampa, ID 83687
Phone (208) 205-7282
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Boise, ID
- NPI 1326336058
Obstetrics & Gynecology
-
dba St Lukes RHC - Trinity Mountain
- Family Medicine Physician
- Mountain Home, ID
- NPI 1417297821
-
dba St Lukes Meridian Medical Center
- General Acute Care Hospital
- Boise, ID
- NPI 1770586794
-
dba St Lukes Nampa Medical Center
- General Acute Care Hospital
- Nampa, ID
- NPI 1831590660
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685577600000",
"number": "1346580842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241",
"fax_number": "740-689-6698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9850 W ST LUKES DR",
"city": "NAMPA",
"state": "ID",
"postal_code": "836877912",
"telephone_number": "208-381-2267"
}
],
"practiceLocations": [
{
"address_1": "112 N Ewing St",
"address_purpose": "LOCATION",
"city": "Lancaster",
"state": "OH",
"postal_code": "431303307",
"country_code": "US",
"telephone_number": "740-689-6690",
"fax_number": "740-689-6698",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRUNER",
"first_name": "JUSTIN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-20",
"last_updated": "2023-06-01",
"certification_date": "2023-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "WA",
"license": "OP60746570",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MI",
"license": "5101020304",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "ID",
"license": "O-1792",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "OH",
"license": "34.014376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.