NPIMap

Individual provider Active NPI

Mason Carter, NP-C

  • Family Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1376188698
Registry record updated Nov 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
53832 Issued in ID
Practice address
21 N Fisher Park Way
Eagle, ID 83616-4796
Phone
(208) 514-0670
NPI assigned
Nov 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 53832 ID Primary

Addresses

Primary practice location

21 N Fisher Park Way
Eagle, ID 83616-4796

Mailing address

1300 N Penn Station LN Apt 201
Meridian, ID 83642-9428

Other practice location 1

21 N Fisher Park Way
Eagle, ID 83616-4796
Phone (208) 514-0670

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
I20200310000119 ID Practitioner - Nurse Practitioner 0941638746 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Key Stone Health CareGroup PAC ID 0648402784, 6 clinicians
Keystone Center for Geriatrics LLCGroup PAC ID 7618365792, 8 clinicians

Practice addresses (Care Compare)

21 N Fisher Park Way
Eagle, ID 83616-4796
Phone (208) 514-0670

305 W Bannock St
Boise, ID 83702-6033
Phone (208) 514-0670

Hospital & facility affiliations

  • Horizon Home Health Home health agency, Meridian, ID, CCN 137065
  • First Choice Home Care Home health agency, Boise, ID, CCN 137108
  • Multicare Home Health Services, Inc Home health agency, Meridian, ID, CCN 137093
  • Horizon Home Health West Home health agency, Caldwell, ID, CCN 137135
  • All Care Health Solutions Home health agency, Eagle, ID, CCN 137121
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
53832IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Hospice, LLC CurrentSince Nov 17, 2019 Accepting new patients
Key Stone Health Care CurrentSince Mar 1, 2020 Accepting new patients
Keystone Center for Geriatrics LLC CurrentSince Nov 1, 2021 Accepting new patients
Marion Luque,PLLC PastSince May 1, 2004 Accepting new patients

Locations

305 W Bannock St
Boise, ID 83702
Phone (208) 514-0670

1139 E Winding Creek Dr
Eagle, ID 83616
Phone (208) 938-8887

21 N Fisher Park Way
Eagle, ID 83616
Phone (208) 514-0670

Organizations & group practices 4

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1376188698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N PENN STATION LN APT 201",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 N FISHER PARK WAY",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164796",
            "telephone_number": "208-514-0670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 N Fisher Park Way",
            "address_purpose": "LOCATION",
            "city": "Eagle",
            "state": "ID",
            "postal_code": "836164796",
            "country_code": "US",
            "telephone_number": "208-514-0670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARTER",
        "first_name": "MASON",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "53832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.