Active NPI
Albert R Trearse, M.D.
- Anesthesiology Physician
- Ketchum, ID
National Provider Identifier
1508864851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- M-6845
- Practice address
- 100 Hospital Dr
Ketchum, ID 83340 - Phone
- (208) 727-8800
- NPI assigned
- Jul 11, 2005
- Last updated
- Jan 25, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | M-6845 | ID | Primary |
| Anesthesiology Physician | 207L00000X | 263133-1205 | UT |
Addresses
Primary practice location
100 Hospital Dr
Ketchum, ID 83340
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 727-8800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508864851 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 263133-1205 | UT | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omega Interventional Pain PLLC | Past | Accepting new patients | |
| Lifetree Medical Inc | Anesthesiology | Past | Accepting new patients |
Interoperability endpoints
- atrearse39530@direct.slhs.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pain Medicine Physician
- Salt Lake City, UT
- NPI 1417253907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1508864851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241",
"telephone_number": "208-727-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HOSPITAL DR",
"city": "KETCHUM",
"state": "ID",
"postal_code": "83340",
"telephone_number": "208-727-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREARSE",
"first_name": "ALBERT",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-11",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "ID",
"license": "M-6845",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "263133-1205",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1508864851",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ketchum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.