Individual provider Active NPI

Andrew Dillon Smith, DO

  • Pediatrics Physician
  • Boise, ID
National Provider Identifier
1366071094
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9571956 Issued in ID
Practice address
8610 W Overland Rd
Boise, ID 83709-1645
Phone
(208) 954-8711
Fax
(208) 375-2217
NPI assigned
Apr 4, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5101027591 MI
Pediatrics Physician 208000000X 9571956 ID Primary

Addresses

Primary practice location

8610 W Overland Rd
Boise, ID 83709-1645

Mailing address

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Other practice location 1

2215 44th St SW
Wyoming, MI 49519-6439
Phone (616) 252-8300

Other practice location 2

5900 Byron Center Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230724001169 MI Practitioner - Pediatric Medicine 5890155709 Reassigns benefits to 1 organization
I20250904005051 ID Practitioner - Pediatric Medicine 5890155709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

777 N Raymond St
Boise, ID 83704-9251

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9571956IDMDPediatrics Physician
5101027591MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Full Circle Health, Inc. CurrentSince Aug 4, 2025 Accepting new patients
Metropolitan Hospital CurrentSince Aug 16, 2023 Accepting new patients
Metropolitan Hospital Past Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030

325 W Idaho St
Boise, ID 83702
Phone (208) 514-2525

6565 W Emerald St
Boise, ID 83704
Phone (208) 377-5055

8610 W Overland Rd
Boise, ID 83709
Phone (208) 514-2500

2275 S Eagle Rd
Ste 120
Meridian, ID 83642
Phone (208) 514-2520

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

2215 44th St SW
Wyoming, MI 49519
Phone (616) 252-8300

Interoperability endpoints

  • Direct secure messaging: asmith139195@direct.metrohealth.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1366071094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8610 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091645",
            "telephone_number": "208-954-8711",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2215 44th St SW",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "495196439",
            "country_code": "US",
            "telephone_number": "616-252-8300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5900 Byron Center Ave SW",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "495199606",
            "country_code": "US",
            "telephone_number": "616-252-8300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ANDREW",
        "middle_name": "DILLON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-04",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101027591",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "9571956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.