NPIMap

Individual provider Active NPI

Scott Donald Willoughby, FNP-C

  • Family Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1457897852
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
54825 Issued in ID
Practice address
4740 N. Penngrove Way
Ste. 100
Meridian, ID 83646
Phone
(208) 938-3663
NPI assigned
Jan 10, 2017
Last updated
Jan 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 54825 ID Primary

Addresses

Primary practice location

4740 N. Penngrove Way
Ste. 100
Meridian, ID 83646

Mailing address

4740 N Penngrove Way Ste 100
Meridian, ID 83646-7446
Phone (208) 938-3663

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Meridian

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
I20170221000909 ID Practitioner - Nurse Practitioner 1951685866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pioneer Family Medicine PLLCGroup PAC ID 5193877850, 13 clinicians

Practice addresses (Care Compare)

4740 N Penngrove Way
Suite 100
Meridian, ID 83646-7446
Phone (208) 938-3663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
54825IDMDFamily Nurse Practitioner

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, 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": "1484006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1457897852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467446",
            "telephone_number": "208-938-3663",
            "fax_number": "208-938-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N. PENNGROVE WAY",
            "address_2": "STE. 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-938-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "SCOTT",
        "middle_name": "DONALD",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-10",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "54825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Meridian",
            "affiliation": "N",
            "address_1": "4740 N Penngrove Way",
            "address_2": "Ste. 100",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "83646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.