NPIMap

Organization Active NPI

High Desert Heart & Vascular

  • Cardiovascular Disease Physician
  • Meridian, ID
National Provider Identifier
1508552043
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
HIGH DESERT HEART & VASCULAR
Practice address
3015 E Goldstone Dr Ste 230
Meridian, ID 83642-1224
Phone
(208) 834-1046
NPI assigned
Apr 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Darren Price
Title
Ceo
Phone
(208) 781-6039

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiac Rehabilitation Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC3500X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X

Addresses

Primary practice location

3015 E Goldstone Dr Ste 230
Meridian, ID 83642-1224

Mailing address

3015 E Goldstone Dr Ste 230
Meridian, ID 83642-1224
Phone (208) 834-1046

Other identifiers 5

IdentifierTypeStateIssuer
1942474853OtherDANIEL NOONAN, MD NPI
1679733414OtherJOSHUA MOZES, MD, NPI
1699720383OtherDANA PEACHEY
1285851337OtherFRED COSTELLO, MD NPI
1710914528OtherDAVID HINCHMAN, MD, NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230810002034 ID Part B Supplier - Clinic/Group Practice 7113389909 Receives reassigned benefits from 10 practitioners
Practice locations: Meridian, ID
O20241206001890 ID Part B Supplier - Intensive Cardiac Rehabilitation 7113389909 Receives reassigned benefits from 4 practitioners
Practice locations: Meridian, ID

National Provider Directory

National Provider Directory

Locations

3015 E Goldstone Dr
Ste 230
Meridian, ID 83642
Phone (208) 398-4306

3015 E Goldstone Dr
Meridian, ID 83642
Phone (208) 398-4306

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1508552043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 E GOLDSTONE DR STE 230",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421224",
            "telephone_number": "208-834-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 E GOLDSTONE DR STE 230",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421224",
            "telephone_number": "208-834-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DESERT HEART & VASCULAR",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-781-6039"
    },
    "taxonomies": [
        {
            "code": "163WC3500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DANIEL NOONAN, MD NPI",
            "identifier": "1942474853",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOSHUA MOZES, MD, NPI",
            "identifier": "1679733414",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DANA PEACHEY",
            "identifier": "1699720383",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FRED COSTELLO, MD NPI",
            "identifier": "1285851337",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVID HINCHMAN, MD, NPI",
            "identifier": "1710914528",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.