NPIMap

Organization Active NPI

Alliance Medical Group, LLC

Doing business as Primary Health Medical Group

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1497991749
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ALLIANCE MEDICAL GROUP, LLC
Doing business as
Primary Health Medical Group
Practice address
1907 Broadway Ave
Suite 101
Boise, ID 83706-4201
Phone
(208) 345-1222
Fax
(208) 345-1261
NPI assigned
Dec 16, 2008
Last updated
Feb 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Authorized official

Name
Linda Barnes
Title
Credentialing MGR
Phone
(208) 985-1423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1907 Broadway Ave
Suite 101
Boise, ID 83706-4201

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500

Other names 1

  • Primary Health Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110826000193 ID DME Supplier - Physician - General Practice 3971544685 Practice locations: Boise, ID

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0521918Primary Health Medical Group - Broadway1907 S Broadway Ave #101, Boise, ID 83706Provider-performed microscopySep 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Alliance Medical Group LLC17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

1907 S Broadway Ave
Boise, ID 83706
Phone (208) 345-1222

1907 S Broadway Ave
Ste 101
Boise, ID 83706
Phone (208) 345-1222

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1229385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1497991749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6500",
            "fax_number": "208-955-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 BROADWAY AVE",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837064201",
            "telephone_number": "208-345-1222",
            "fax_number": "208-345-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-16",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "CREDENTIALING MGR",
        "authorized_official_telephone_number": "208-985-1423"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Health Medical Group",
            "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 Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.