Active NPI
Susan Marguerite Owen
- Family Nurse Practitioner
- Eagle, ID
National Provider Identifier
1366317364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 5471685
- Practice address
- 2862 E Shadowview St
Eagle, ID 83616-5670 - Phone
- (208) 801-3728
- NPI assigned
- Oct 8, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 72955 | ID | |
| Family Nurse Practitioner | 363LF0000X | 5471685 | ID | Primary |
Addresses
Primary practice location
2862 E Shadowview St
Eagle, ID 83616-5670
Mailing address
2862 E Shadowview St
Eagle, ID 83616-5670
Phone (208) 801-3728
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1333 E Madison Ave
Suite 201
El Cajon, CA 92021-8573
633 N 4TH St
Boise, ID 83702-4510
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72955 | ID | MD | Registered Nurse |
| 5471685 | ID | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pain Center Inc | Single Specialty | Current | Accepting new patients |
Locations
633 N 4th St
Boise, ID 83702
Phone (208) 342-9800
1825 S Kimball Ave
Caldwell, ID 83605
Phone (208) 454-0567
Interoperability endpoints
- https://api.platform.athenahealth.com/13461/brand/1/csg/1/fhir/r4
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1366317364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2862 E SHADOWVIEW ST",
"city": "EAGLE",
"state": "ID",
"postal_code": "836165670",
"telephone_number": "208-801-3728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2862 E SHADOWVIEW ST",
"city": "EAGLE",
"state": "ID",
"postal_code": "836165670",
"telephone_number": "208-801-3728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OWEN",
"first_name": "SUSAN",
"middle_name": "MARGUERITE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-10-08",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "72955",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "ID",
"license": "5471685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.