Exodus Pain Clinic

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

M9452 Issued in ID

Legal business name

EXODUS PAIN CLINIC

Practice address

987 S Allante PL
Boise, ID 83709-1612

Phone

(208) 947-7246

Fax

(208) 297-7772

NPI assigned

Dec 3, 2014

Organization subpart

No

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

Authorized official

Name

Daniel Marsh, MDNPI 1356377535

Title

MD/Owner

Phone

(208) 994-2907

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Richard Marsh, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Boise, ID
  • NPI 1356377535

  ID

  Medicare reassignment Care Compare group NPD Authorized official
• Slavik Osipchuk, NP

  • Pain Medicine Physician
  • Boise, ID
  • NPI 1164043162

  ID, Single Specialty

  Medicare reassignment Care Compare group NPD
• Susan Sansom, CNP

  • Nurse Practitioner
  • Meridian, ID
  • NPI 1538611397

  ID

  Medicare reassignment NPD
• Scott R Coleman, PA-C

  • Physician Assistant
  • Boise, ID
  • NPI 1649352139

  ID

  Medicare reassignment
• James H Morland, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Meridian, ID
  • NPI 1215975164
  NPD (past)
• Thomas M Rambow, PA-C

  • Physician Assistant
  • Boise, ID
  • NPI 1679534184
  NPD (past)

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1366849572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 S ALLANTE PL",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091612",
            "telephone_number": "208-947-7246",
            "fax_number": "208-297-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 S ALLANTE PL",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091612",
            "telephone_number": "208-947-7246",
            "fax_number": "208-297-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXODUS PAIN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "MARSH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "208-994-2907",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "ID",
            "license": "M9452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356377535",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Boise, ID
• Interventional Pain Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.