Keith G Holley, MD
Individual provider Active NPI Adult Reconstructive Orthopaedic Surgery Physician · Nampa, ID
NPI 1386616183 · NPPES record last updated Oct 22, 2014
Key facts
- NPI
- 1386616183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X
- License
- M-11367 (ID)
- Practice address
- 4424 E Flamingo Ave
Suite 110
Nampa, ID 83687 - Phone
- (208) 288-4700
- Fax
- (208) 288-4720
- NPI assigned
- Feb 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- University of Texas Medical Branch at Galveston, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Allied Orthopaedics LLC
Practice addresses (Care Compare)
7979 W Rifleman St
Suite 100
Boise, ID 83704-9066
Phone (208) 855-2410
Hospital & facility affiliations
- Treasure Valley Hospital
- Saint Alphonsus Medical Center - Nampa
- Saint Alphonsus Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 27 |
| Knee replacement | 56 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Treasure Valley Hospital |
Hospital | Limited Partnership Interest (1.41%) | Jun 28, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110805000191 | ID | Practitioner - Orthopedic Surgery | 1658418371 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00045579 | WA | MD | Adult Reconstructive Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Orthopaedics LLC | Adult Reconstructive Orthopaedic Surgery | Current |
Accepting new patients |
| Allied Orthopaedics LLC | Adult Reconstructive Orthopaedic Surgery | Current |
Accepting new patients |
| Direct Orthopedic Care LLC | Adult Reconstructive Orthopaedic Surgery | Past |
Accepting new patients |
Locations
7979 W Rifleman St
Boise, ID 83704
Phone (208) 321-4000
7979 W Rifleman St
Ste 100
Boise, ID 83704
Phone (208) 375-6133
3015 E Magic View Dr
Ste 130
Meridian, ID 83642
Phone (208) 482-5567
16818 N Marketplace Blvd
Nampa, ID 83687
Phone (208) 321-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Reconstructive Orthopaedic Surgery Physician | 207XS0114X | MD00045579 | WA | |
| Adult Reconstructive Orthopaedic Surgery Physician | 207XS0114X | M-11367 | ID | Yes |
Addresses
Primary practice location
4424 E Flamingo Ave
Suite 110
Nampa, ID 83687
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386616183 | Medicaid | ID |
Other providers in Nampa, ID
- Nicholas W. Hodgman
- Bonnie Hoewing
- Kathy Lynn Hohenbrink
- Shauni Holcomb
- Holistic Healthcare LLC.
- Tyler James Holloway
- Holly Lane Rehabilitation and Healthcare Center, LLC
- Sydney K Holmes
- Wendi Holmes
- Rebecca Lynn Holmstead
All providers in Nampa, ID · Adult Reconstructive Orthopaedic Surgery Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.