Ann C Agnew, MD
Individual provider Active NPI Internal Medicine Physician · Meridian, ID
NPI 1497797302 · NPPES record last updated Jul 16, 2018
Key facts
- NPI
- 1497797302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- M9138 (ID)
- Practice address
- 3080 E Gentry Way Ste 210
Meridian, ID 83642-3013 - Phone
- (208) 947-5390
- Fax
- (208) 947-3465
- NPI assigned
- Jun 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Copper Falls Hospice LLC |
Hospice | Contracted Managing Employee | Nov 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040930000523 | ID | Practitioner - Internal Medicine |
5597734012 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M9138 | ID | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rocky Mountain Care - Palliative Care LLC | Internal Medicine | Current |
Accepting new patients |
| Physician Groups LC | Internal Medicine | Past | Accepting new patients |
| Inpatient Consultants of Missouri Inc | Internal Medicine | Past | Accepting new patients |
| Saint Alphonsus Regional Medical Center Inc | Internal Medicine | Past | Accepting new patients |
| Apogee Medical Group Idaho PC | Internal Medicine | Past | Accepting new patients |
Locations
2100 Northwest Blvd
Ste 120
Coeur D Alene, ID 83814
Phone (208) 505-4060
598 W 900 S
Ste 220
Woods Cross, UT 84010
Phone (801) 693-2310
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | M9138 | ID | |
| Internal Medicine Physician | 207R00000X | M9138 | ID | Yes |
Addresses
Primary practice location
3080 E Gentry Way Ste 210
Meridian, ID 83642-3013
Mailing address
1070 E Opus St
Boise, ID 83716-5274
Phone (208) 344-4824
Other practice location 1
1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-7350
Other practice location 2
1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-7350
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806964100 | Medicaid | ID |
Other providers in Meridian, ID
- Aegis Group Practice LLC
- Aesthetic Smiles
- Aesthetic Smiles P LLC
- Ageless Women'S Health Id LLC
- Yelizaveta Agiy
- Melissa M. M. Agoudemos
- Phillip C Agrusa
- Ahc Home Health of Boise LLC
- Ahc Medical Supply, LLC
- Ahc of Boise LLC
All providers in Meridian, ID · Internal Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.