NPIMap

Individual provider Active NPI

Cynthia Fairfax, M.D.

  • Urology Physician
  • Meridian, ID
National Provider Identifier
1417906330
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
M-6803 Issued in ID
Practice address
2855 E Magic View Dr
Meridian, ID 83642-6245
Phone
(208) 639-4900
Fax
(208) 639-4901
NPI assigned
May 8, 2006
Last updated
Feb 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X M-6803 ID Primary

Addresses

Primary practice location

2855 E Magic View Dr
Meridian, ID 83642-6245

Mailing address

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

Other identifiers 5

IdentifierTypeStateIssuer
2571800MedicaidID
B5600OtherIDBLUE CROSS MERIDIAN
000010000852OtherIDBLUE SHIELD BOISE
000010157304OtherIDBLUE SHIELD MERIDIAN
75663OtherIDBLUE CROSS BOISE

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
I20050817001177 ID Practitioner - Urology 1254361769 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Oregon Health Sciences University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Urologic Institute PAGroup PAC ID 9537199039, 20 clinicians

Practice addresses (Care Compare)

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Urologic Institute PA Urology CurrentSince Aug 1, 2005 Accepting new patients
Steele Memorial Medical Center CurrentSince Nov 19, 2017 Accepting new patients
Steele Memorial Medical Center CurrentSince Nov 19, 2017 Accepting new patients
Steele Memorial Medical Center Past Accepting new patients

Locations

222 N 2nd St
Ste 115
Boise, ID 83702
Phone (208) 336-3232

333 N 1st St
Ste 100
Boise, ID 83702
Phone (208) 343-7736

2855 E Magic View Dr
Meridian, ID 83642
Phone (208) 639-4900

203 S Daisy St
Salmon, ID 83467
Phone (208) 756-4291

Interoperability endpoints

  • Direct secure messaging: cfairfax1563993@direct.trinity-health.org
  • Direct secure messaging: cfairfax444444@wm.providencedirect.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 8

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": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1417906330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRFAX",
        "first_name": "CYNTHIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "M-6803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2571800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS  MERIDIAN",
            "identifier": "B5600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD BOISE",
            "identifier": "000010000852",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD MERIDIAN",
            "identifier": "000010157304",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BOISE",
            "identifier": "75663",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.