NPIMap

Organization Active NPI

Therapeutic Associates Inc

Doing business as TAI SE Boise

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1487630240
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
THERAPEUTIC ASSOCIATES INC
Doing business as
TAI SE Boise
Practice address
960 S Broadway Ave Ste 200
Boise, ID 83706-3600
Phone
(208) 433-9211
Fax
(208) 433-9241
NPI assigned
Dec 22, 2005
Last updated
May 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Authorized official

Name
Mr. Todd Robert Gifford, PTNPI 1770933061
Title
Information Systems Director
Phone
(503) 443-6156

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X ID Primary

Addresses

Primary practice location

960 S Broadway Ave Ste 200
Boise, ID 83706-3600

Mailing address

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other identifiers 4

IdentifierTypeStateIssuer
1487630240-000MedicaidID
197670349MedicaidID
1487630240MedicaidID
197670349OtherIDOWCP

Other names 1

  • TAI SE Boise Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040515000415 ID Part B Supplier - Clinic/Group Practice 0042116279 Receives reassigned benefits from 34 practitioners
7 other NPIs on this enrollment
Practice locations: Boise, ID; Nampa, ID; Meridian, ID; Eagle, ID

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Central Physical Therap100 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

960 S Broadway Ave
Ste 200
Boise, ID 83706
Phone (208) 433-9211

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430870400000",
    "number": "1487630240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD",
            "address_2": "STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-443-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 S BROADWAY AVE STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063600",
            "telephone_number": "208-433-9211",
            "fax_number": "208-433-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTIC ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2015-05-06",
        "status": "A",
        "authorized_official_last_name": "GIFFORD",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "INFORMATION SYSTEMS DIRECTOR",
        "authorized_official_telephone_number": "503-443-6156",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487630240-000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197670349",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487630240",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "197670349",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAI SE Boise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.