Richard Radnovich, DO

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

O-259 Issued in ID

Practice address

4850 N Rosepoint Way
Ste 100
Boise, ID 83713

Phone

(208) 939-2100

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

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.

• Boise State University

  dba Boise State University Public Health Clinic

  • Community Health Clinic/Center
  • Boise, ID
  • NPI 1134905243
  Medicare reassignment NPD
• Injury Care Emergency Medical Services

  • Land Ambulance
  • Boise, ID
  • NPI 1093952947
  NPD Authorized official
• Back Care of Toledo, LLC

  dba Dunne Chiropractic, LLC

  • Chiropractor
  • Toledo, OH
  • NPI 1104043389
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1407944655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 N ROSEPOINT WAY",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 N ROSEPOINT WAY",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83713",
            "telephone_number": "208-939-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADNOVICH",
        "first_name": "RICHARD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ID",
            "license": "O-259",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "ID",
            "license": "O-259",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806047900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kendall Hugh Rader, M.D.
• Wilbur Allen Rader, M.D.
• Claire Heitzman Radice, PT
• Jennifer Alejandra Radilla Quijas, LMSW
• Angela Hoffman Radimer, PA
• Rae of Sunshine Therapy LLC
• Brian J Rae, D.C.
• Donald D Rae, D.C.
• Erin M Rae, R.D.
• Michael D. Rae, D.C.

• Sports Medicine (Family Medicine) Physician in Boise, ID
• Providers in Boise, ID by specialty
• Sports Medicine (Family Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.