Individual provider Active NPI

Lauren Marie Tibbits, MD

  • Emergency Medicine Physician
  • Meridian, ID
National Provider Identifier
1417535048
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
3571562 Issued in ID
Practice address
3080 E Gentry Way Ste 210
Meridian, ID 83642-3013
Phone
(986) 224-3600
NPI assigned
Apr 2, 2021
Last updated
Jul 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 3571562 ID Primary

Addresses

Primary practice location

3080 E Gentry Way Ste 210
Meridian, ID 83642-3013

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2235

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ID2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250429000146 TX Practitioner - Emergency Medicine 5698291136 Reassigns benefits to 1 organization
I20250814004430 ID Practitioner - Emergency Medicine 5698291136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Human Medicine, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Boise, ID 83701

PO Box
Suite 640
Boise, ID 83701-0640

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3571562IDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Services of TX, PLLC Emergency Medicine CurrentSince Feb 1, 2025 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Emergency Medicine CurrentSince Jul 31, 2025 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

225 E Parkwood Ave
Friendswood, TX 77546
Phone (281) 549-9400

11100 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 770-7000

1310 McCullough Ave
San Antonio, TX 78212
Phone (210) 208-2200

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

26306 Kuykendahl Rd
Tomball, TX 77375
Phone (346) 246-7700

Organizations & group practices 2

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 3

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": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1417535048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 210",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423013",
            "telephone_number": "986-224-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 E Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837126241",
            "country_code": "US",
            "telephone_number": "208-381-2235",
            "fax_number": "208-381-4556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIBBITS",
        "first_name": "LAUREN",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "3571562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.