NPIMap

Individual provider Active NPI

Jeremy David Waldram, M.D.

  • Allergy & Immunology Physician
  • Boise, ID
National Provider Identifier
1396972311
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
M-15024 Issued in ID
Practice address
1000 N Curtis Rd Ste 303
Boise, ID 83706-1347
Phone
(208) 377-4000
NPI assigned
Jun 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01069478A IN
Allergy & Immunology Physician 207K00000X M-15024 ID Primary

Addresses

Primary practice location

1000 N Curtis Rd Ste 303
Boise, ID 83706-1347

Mailing address

1000 N Curtis Rd Ste 303
Boise, ID 83706-1347
Phone (208) 377-4000

Other practice location 1

Naval Medical Ctr
34800 Bob Wilson Dr
San Diego, CA 92134-5000
Phone (619) 216-0466

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
I20200729001127 ID Practitioner - Allergy/Immunology 5698926855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
University of Southern California Keck School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allergy Group PCGroup PAC ID 5799747317, 7 clinicians

Practice addresses (Care Compare)

1000 N Curtis Rd
Suite 303
Boise, ID 83706-1347
Phone (208) 377-4000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy Group PC Allergy & Immunology CurrentSince Aug 11, 2020 Accepting new patients

Locations

1000 N Curtis Rd
Ste 303
Boise, ID 83706
Phone (208) 322-5351

323 E Riverside Dr
Ste 220
Eagle, ID 83616
Phone (208) 343-5600

2273 E Gala St
Ste 110
Meridian, ID 83642
Phone (208) 994-5700

Organizations & group practices 1

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 7

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": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1396972311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N CURTIS RD STE 303",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061347",
            "telephone_number": "208-377-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N CURTIS RD STE 303",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061347",
            "telephone_number": "208-377-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Naval Medical Ctr",
            "address_2": "34800 Bob Wilson Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921345000",
            "country_code": "US",
            "telephone_number": "619-216-0466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDRAM",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-17",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01069478A",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "ID",
            "license": "M-15024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.