NPIMap

Individual provider Active NPI

Nathan R. Mason, MD

  • Family Medicine Physician
  • Star, ID
National Provider Identifier
1396953196
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-15457 Issued in ID
Practice address
10717 W State St
Star, ID 83669-6046
Phone
(208) 302-6300
Fax
(208) 302-6355
NPI assigned
May 18, 2007
Last updated
Feb 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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 MD125936 OR
Family Medicine Physician 207Q00000X M-15457 ID Primary

Addresses

Primary practice location

10717 W State St
Star, ID 83669-6046

Mailing address

3340 E Goldstone Dr
Meridian, ID 83642-1026
Phone (208) 367-5170

Other practice location 1

679 Main St
Sweet Home, OR 97386-3305
Phone (541) 451-6250

Other identifiers 1

IdentifierTypeStateIssuer
500608912MedicaidOR

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
I20210222003038 ID Practitioner - Family Practice 7911053525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10717 W State St
Star, ID 83669-6046
Phone (208) 302-6300

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-15457IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Family Medicine CurrentSince Apr 1, 2021 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Apr 1, 2021 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Firstcare Medical Foundation Family Medicine Past Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

10717 W State St
Star, ID 83669
Phone (208) 302-6300

Interoperability endpoints

  • Direct secure messaging: nmason1564193@direct.trinity-health.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1396953196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10717 W STATE ST",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836696046",
            "telephone_number": "208-302-6300",
            "fax_number": "208-302-6355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "679 Main St",
            "address_purpose": "LOCATION",
            "city": "Sweet Home",
            "state": "OR",
            "postal_code": "973863305",
            "country_code": "US",
            "telephone_number": "541-451-6250",
            "fax_number": "541-451-6277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASON",
        "first_name": "NATHAN",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD125936",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-15457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500608912",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Star, ID

Sources for this page

Verify at the official NPI Registry.