NPIMap

Individual provider Active NPI

Brandy Marie Tacia, DO

  • Otolaryngology Physician
  • Post Falls, ID
National Provider Identifier
1467667550
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
O-0622 Issued in ID
Practice address
750 N Syringa St Ste 203a
Post Falls, ID 83854-5275
Phone
(208) 262-2717
Fax
(208) 262-2719
NPI assigned
May 11, 2007
Last updated
May 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X O-0622 ID Primary
Facial Plastic Surgery Physician 207YS0123X O-0622 ID

Addresses

Primary practice location

750 N Syringa St Ste 203a
Post Falls, ID 83854-5275

Mailing address

1593 E Polston Ave
Post Falls, ID 83854-5326
Phone (208) 262-2300

Other identifiers 2

IdentifierTypeStateIssuer
2013695MedicaidWA
1467667550MedicaidID

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
I20110808000542 ID Practitioner - Otolaryngology 4486823432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Idaho Day Surgery LLCGroup PAC ID 0840101218, 87 clinicians

Practice addresses (Care Compare)

750 N Syringa St
Suite 203a
Post Falls, ID 83854-5275
Phone (208) 262-2717

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-0622IDMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Idaho Day Surgery LLC CurrentSince Aug 1, 2017 Accepting new patients

Locations

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

1593 E Polston Ave
Post Falls, ID 83854
Phone (208) 262-2300

750 N Syringa St
Ste 100
Post Falls, ID 83854
Phone (208) 262-2600

750 N Syringa St
Ste 203A
Post Falls, ID 83854
Phone (208) 262-2717

Interoperability endpoints

  • Direct secure messaging: btacia@nwsh.gwaydirect.com

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 7

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": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1467667550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1593 E POLSTON AVE",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838545326",
            "telephone_number": "208-262-2300",
            "fax_number": "208-262-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N SYRINGA ST STE 203A",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838545275",
            "telephone_number": "208-262-2717",
            "fax_number": "208-262-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACIA",
        "first_name": "BRANDY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ID",
            "license": "O-0622",
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "ID",
            "license": "O-0622",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2013695",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467667550",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Post Falls, ID

Sources for this page

Verify at the official NPI Registry.