NPIMap

Individual provider Active NPI

Ryann Lynn Lagomarsino

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1366091639
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2013 Issued in ID
Practice address
333 N 1St St Ste 240
Boise, ID 83702-6132
Phone
(208) 338-8900
Fax
(208) 947-1190
NPI assigned
Sep 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2013 ID Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

333 N 1St St Ste 240
Boise, ID 83702-6132

Mailing address

333 N 1St St Ste 240
Boise, ID 83702-6132
Phone (208) 338-8900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210331002930 ID Practitioner - Physician Assistant 3476960873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Washington School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Women'S Health Associates, PLLCGroup PAC ID 4082630587, 19 clinicians

Practice addresses (Care Compare)

333 N 1St St
Boise, ID 83702-6132
Phone (208) 338-8900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2013IDMDPhysician Assistant

Organizations & group practices 1

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1366091639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N 1ST ST STE 240",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026132",
            "telephone_number": "208-338-8900",
            "fax_number": "208-947-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N 1ST ST STE 240",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026132",
            "telephone_number": "208-338-8900",
            "fax_number": "208-947-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGOMARSINO",
        "first_name": "RYANN",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-09",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA2013",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.