Individual provider Active NPI

Susan Marguerite Owen

  • Family Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1366317364
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5471685 Issued in ID
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

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 72955 ID
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251231002856 ID Practitioner - Nurse Practitioner 9830685577 Reassigns benefits to 1 organization

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

LicenseStateTypeSpecialty
72955IDMDRegistered Nurse
5471685IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Center Inc Single Specialty CurrentSince Dec 1, 2025 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

  • FHIR API: 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

Verify at the official NPI Registry.