NPIMap

Individual provider Active NPI

Julianne Hollist, NP-C

  • Gerontology Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1356976039
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
63993 Issued in ID
Practice address
55 W Willowbrook Dr Ste 103
Meridian, ID 83646-3242
Phone
(208) 402-9956
NPI assigned
Mar 3, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 63993 ID
Gerontology Nurse Practitioner 363LG0600X 63993 ID Primary

Addresses

Primary practice location

55 W Willowbrook Dr Ste 103
Meridian, ID 83646-3242

Mailing address

55 W Willowbrook Dr
Ste 103
Meridian, ID 83646-3242
Phone (208) 402-9956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200417003072 ID Practitioner - Nurse Practitioner 5496185274 Reassigns benefits to 1 organization
I20221013001928 OR Practitioner - Nurse Practitioner 5496185274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clair Specialty Physicians PCGroup PAC ID 6204733256, 36 clinicians

Practice addresses (Care Compare)

515 E LN S
Ontario, OR 97914-3953
Phone (208) 501-8955

5610 W Gage St
Suite a
Boise, ID 83706-1332
Phone (208) 367-3370

Hospital & facility affiliations

  • Grande Ronde Hospital Hospital, La Grande, OR, CCN 381321
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
63993IDMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Specialty Physicians PC CurrentSince Jul 18, 2022 Accepting new patients
Idaho Nephrology Associates, L.L.C Past Accepting new patients

Locations

5610 W Gage St
Ste A
Boise, ID 83706
Phone (208) 367-3370

1818 S 10th Ave
Ste 120
Caldwell, ID 83605
Phone (208) 468-5959

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

840 N 4th E
Mountain Home, ID 83647
Phone (208) 587-1850

45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300

45640 Schoenherr Rd
Utica, MI 48315
Phone (586) 247-4300

3175 Pocahontas Rd
Baker City, OR 97814
Phone (208) 302-2200

515 East Ln S
Ontario, OR 97914
Phone (208) 501-8955

Interoperability endpoints

  • Direct secure messaging: juliannehollist@stclairspe.allscriptsdirect.net

Organizations & group practices 2

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1356976039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W WILLOWBROOK DR",
            "address_2": "STE 103",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836463242",
            "telephone_number": "208-402-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 W WILLOWBROOK DR STE 103",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836463242",
            "telephone_number": "208-402-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIST",
        "first_name": "JULIANNE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "ID",
            "license": "63993",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ID",
            "license": "63993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.