NPIMap

Individual provider Active NPI

Dan J Hendrickson, M.D.

  • Pulmonary Disease Physician
  • Nampa, ID
National Provider Identifier
1467525949
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
M-9672 Issued in ID
Practice address
401 E Hawaii
Nampa, ID 83686
Phone
(208) 302-2100
Fax
(208) 302-2125
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X M-9672 ID Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X M-9672 ID

Addresses

Primary practice location

401 E Hawaii
Nampa, ID 83686

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 302-2100

Other identifiers 2

IdentifierTypeStateIssuer
000010158154OtherIDREGENCE
807658900MedicaidID

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
I20070416000166 ID Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 9335121961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
University of Nebraska College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vibra Physicians LLCGroup PAC ID 8921233933, 30 clinicians

Practice addresses (Care Compare)

2131 S Bonito Way
Meridian, ID 83642-1659
Phone (208) 489-9500

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vibra Physicians LLC CurrentSince Sep 1, 2017 Accepting new patients
Caldwell Internal Medicine Professional Association Past Accepting new patients
West Valley Medical Group LLC PastSince Oct 1, 2006 Accepting new patients
Idaho Pulmonary Associates, PA Pulmonary Disease Past Accepting new patients
Texas Tech University Health Sciences Center Odessa Past Accepting new patients
Ector County Hospital District Past Accepting new patients
Saint Alphonsus Specialty Services Inc Past Accepting new patients
West Valley Medical Group Specialty Services LLC Past Accepting new patients

Locations

6651 W Franklin Rd
Boise, ID 83709
Phone (208) 323-0031

2131 S Bonito Way
Meridian, ID 83642
Phone (208) 202-4700

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1467525949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-2100",
            "fax_number": "208-302-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HAWAII",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-302-2100",
            "fax_number": "208-302-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "DAN",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ID",
            "license": "M-9672",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "ID",
            "license": "M-9672",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "000010158154",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807658900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.