Comprehensive Dermatology of Idaho, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

M8483 Issued in ID

Legal business name

COMPREHENSIVE DERMATOLOGY OF IDAHO, PLLC

Practice address

16111 N Brinson St Ste 100
Nampa, ID 83687-5509

Phone

(208) 467-7546

Fax

(208) 467-7500

NPI assigned

Nov 5, 2011

Last updated

Dec 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Scott Owsley, M.D.NPI 1659361681

Title

Owner

Phone

(208) 467-7546

Specialties & licenses 2

Addresses

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

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00057

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Scott Owsley, MD

  • Dermatology Physician
  • Nampa, ID
  • NPI 1659361681
  Medicare reassignment Care Compare group Authorized official
• Jock C Perkins, PA-C

  • Physician Assistant
  • Nampa, ID
  • NPI 1306248778
  Medicare reassignment Care Compare group
• Amanda Lynn Turner, PA

  • Physician Assistant
  • Gresham, OR
  • NPI 1093228769

  ID

  Medicare reassignment Care Compare group
• Samantha A Conley, FNP

  • Family Nurse Practitioner
  • Boise, ID
  • NPI 1609585199
  NPD (past)

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

{
    "created_epoch": "1320451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577059200000",
    "number": "1386921294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16111 N BRINSON ST STE 100",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875509",
            "telephone_number": "208-467-7546",
            "fax_number": "208-467-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16111 N BRINSON ST STE 100",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875509",
            "telephone_number": "208-467-7546",
            "fax_number": "208-467-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE DERMATOLOGY OF IDAHO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-05",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A",
        "authorized_official_last_name": "OWSLEY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-467-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA280",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M8483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Nampa, ID
• Providers in Nampa, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; 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.