NPIMap

Individual provider Active NPI

Michael Robert Nieraeth, PA

  • Surgical Physician Assistant
  • Boise, ID
National Provider Identifier
1487904280
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA-993 Issued in ID
Practice address
8854 W Emerald St Ste 102
Boise, ID 83704
Phone
(208) 323-4747
Fax
(208) 323-4848
NPI assigned
Sep 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA-993 ID Primary

Addresses

Primary practice location

8854 W Emerald St Ste 102
Boise, ID 83704

Mailing address

8854 W Emerald St Ste 102
Boise, ID 83704-4845
Phone (208) 323-4747

Other practice location 1

320 Warner Dr
Lewiston, ID 83501-4441
Phone (208) 743-3523

Other identifiers 1

IdentifierTypeStateIssuer
1487904280MedicaidID

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
I20130123000158 ID Practitioner - Physician Assistant 9133372501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Shoulder Clinic of Idaho PLLCGroup PAC ID 5698860021, 5 clinicians

Practice addresses (Care Compare)

8854 W Emerald St
Suite 102
Boise, ID 83704-4845
Phone (208) 323-4747

Hospital & facility affiliations

  • Treasure Valley Hospital Hospital, Boise, ID, CCN 130063
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Wood River Medical Center Hospital, Ketchum, ID, CCN 131323
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Lochhead MD PLLC PastSince Jul 1, 2015 Accepting new patients
Orthopedic & Fracture Clinic PA PastSince Aug 18, 2024 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mike.nieraeth@1488.chartlogic.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1487904280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044845",
            "telephone_number": "208-323-4747",
            "fax_number": "208-323-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-323-4747",
            "fax_number": "208-323-4848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Warner Dr",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ID",
            "postal_code": "835014441",
            "country_code": "US",
            "telephone_number": "208-743-3523",
            "fax_number": "208-746-8741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIERAETH",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-19",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487904280",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.