Active NPI
Kip T Katseanes, DMD MSD
- Dentist
- Boise, ID
National Provider Identifier
1366824484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D5185PE
- Practice address
- 6019 N Eagle Rd
Boise, ID 83713 - Phone
- (208) 377-2777
- Fax
- (208) 377-3075
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D5185PE | ID | Primary |
Addresses
Primary practice location
6019 N Eagle Rd
Boise, ID 83713
Mailing address
6019 N Eagle Rd
Boise, ID 83713
Phone (208) 377-2777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 19, 2019 through Jun 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5185PE | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sawtooth Periodontics PLLC | Current | Accepting new patients |
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": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1366824484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6019 N EAGLE RD",
"city": "BOISE",
"state": "ID",
"postal_code": "83713",
"telephone_number": "208-377-2777",
"fax_number": "208-377-3075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6019 N EAGLE RD",
"city": "BOISE",
"state": "ID",
"postal_code": "83713",
"telephone_number": "208-377-2777",
"fax_number": "208-377-3075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KATSEANES",
"first_name": "KIP",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DMD MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-25",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D5185PE",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
- Ameer Kathem
- Kathryn Metzger, LCSW, PLLC
- Kathy Matlock Tidwell (Tidwell Social Work Services & Consulting)
- Katie Grohs Counseling LLC
- Kristina M. Katinka, MSOM L.AC.
- Jon R Kattenhorn, MD
- Jill Hancock Kauffman Vanheel, MSW
- Christopher Raymond Kauffman, M.D.
- Jessica Rose Kaufman, BCBA
- Gurshan Kaur, DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.