NPIMap

Organization Active NPI

Boise Family Medicine Center

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1376747790
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOISE FAMILY MEDICINE CENTER
Practice address
10798 W. Overland Rd
Boise, ID 83709-1329
Phone
(208) 377-3368
Fax
(208) 322-4691
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

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

Authorized official

Name
Dr. Dale L Mock, M.D.NPI 1215948351
Title
Owner/Physician
Phone
(208) 377-3368

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

10798 W. Overland Rd
Boise, ID 83709-1329

Mailing address

10798 W. Overland Rd
Boise, ID 83709-1329
Phone (208) 377-3368

Other identifiers 5

IdentifierTypeStateIssuer
002643200MedicaidID
32110OtherIDBLUE CROSS
000010006306OtherIDBLUE SHIELD
000010006306OtherIDBLUE SHIELD GROUP NUMBER
32110OtherIDBLUE CROSS GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283904000000",
    "number": "1376747790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10798 W. OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091329",
            "telephone_number": "208-377-3368",
            "fax_number": "208-322-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10798 W. OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091329",
            "telephone_number": "208-377-3368",
            "fax_number": "208-322-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE FAMILY MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2010-09-08",
        "status": "A",
        "authorized_official_last_name": "MOCK",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "208-377-3368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002643200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "32110",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010006306",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "000010006306",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "32110",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.