NPIMap

Individual provider Active NPI

Mark A Johnson, DO

  • Family Medicine Physician
  • Meridian, ID
National Provider Identifier
1376707034
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-0583 Issued in ID
Practice address
1524 W Cayuse Creek Dr
Meridian, ID 83646-4795
Phone
(208) 937-8372
Fax
(208) 616-1606
NPI assigned
Jul 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-0583 ID Primary
Family Medicine Physician 207Q00000X OL20000133 WA

Addresses

Primary practice location

1524 W Cayuse Creek Dr
Meridian, ID 83646-4795

Mailing address

1524 W Cayuse Creek Dr
Meridian, ID 83646-4795
Phone (208) 937-8372

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 12, 2026 through Jan 12, 2028

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

PO Box
Suite 191050
Boise, ID 83719

PO Box
Suite 191050
Boise, ID 83719-1050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OL20000133WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC Family Medicine Current Accepting new patients
East West DPC Family Medicine PastSince Feb 19, 2023 Accepting new patients
Alliance Medical Group, LLC Family Medicine Past Accepting new patients

Locations

1907 S Broadway Ave
Boise, ID 83706
Phone (208) 345-1222

8971 W Overland Rd
Boise, ID 83709
Phone (208) 378-4288

4971 W Overland Rd
Boise, ID 83705
Phone (208) 472-5050

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

1474 N Meridian Rd
Kuna, ID 83634
Phone (208) 809-2885

1623 S Wells Ave
Meridian, ID 83642
Phone (208) 489-1450

1900 W Chinden Blvd
Meridian, ID 83646
Phone (208) 809-2860

1648 NW 1st St
Meridian, ID 83642
Phone (208) 888-9393

3280 E Lanark Dr
Meridian, ID 83642
Phone (208) 377-4400

1375 N Happy Valley Rd
Nampa, ID 83687
Phone (208) 809-2869

Interoperability endpoints

  • Direct secure messaging: mark.johnson@phmg.eclinicaldirectplus.com

Organizations & group practices 3

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1376707034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 W CAYUSE CREEK DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836464795",
            "telephone_number": "208-937-8372",
            "fax_number": "208-616-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 W CAYUSE CREEK DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836464795",
            "telephone_number": "208-937-8372",
            "fax_number": "208-616-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-11",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0583",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OL20000133",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.