Greg C Boettcher, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0237 Issued in ID

Practice address

267 N Canyon Dr
Gooding, ID 83330

Phone

(208) 934-4446

Fax

(208) 934-4442

NPI assigned

Jul 8, 2006

Last updated

Jul 10, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Canyon Medical Center IncGroup PAC ID 0941371439, 73 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Canyon Medical Center Hospital, Gooding, ID, CCN 131302
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
• Minidoka Memorial Hospital Hospital, Rupert, ID, CCN 131319

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• North Canyon Medical Center, Inc.

  dba North Canyon Buhl Clinic

  • Rural Health Clinic/Center
  • Buhl, ID
  • NPI 1568950566

  W-2 Managing Employee

  CMS ownership

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.

• North Canyon Medical Center Inc.

  dba North Canyon Medical Center

  • Critical Access Hospital
  • Gooding, ID
  • NPI 1609046671
  Medicare reassignment Care Compare group NPD
• North Canyon Medical Center, Inc.

  dba North Canyon Imaging Center Twin Falls

  • Radiology Clinic/Center
  • Twin Falls, ID
  • NPI 1700641636
  NPD
• Inland Cardiology Associates, P.S.

  • Cardiovascular Disease Physician
  • Spokane, WA
  • NPI 1679522106
  NPD (past)
• Preferred Emergency Physicians

  • Emergency Medicine Physician
  • Portland, IN
  • NPI 1457302077
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Minidoka Memorial Hospital

  • Critical Access Hospital
  • Rupert, ID
  • NPI 1679553531
  Care Compare affiliation
• North Canyon Medical Center Inc.

  dba North Canyon Medical Center

  • Critical Access Hospital
  • Gooding, ID
  • NPI 1609046671
  Care Compare affiliation
• St. Luke's Magic Valley Regional Medical Center, LTD.

  dba St Lukes Magic Valley - Air Ambulance

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1508899295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 N CANYON DR",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833305500",
            "telephone_number": "208-934-4446",
            "fax_number": "208-934-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 N CANYON DR",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "83330",
            "telephone_number": "208-934-4446",
            "fax_number": "208-934-4442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1218 9th St Ste 7",
            "address_purpose": "LOCATION",
            "city": "Rupert",
            "state": "ID",
            "postal_code": "833502207",
            "country_code": "US",
            "telephone_number": "208-436-3161",
            "fax_number": "208-463-3163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOETTCHER",
        "first_name": "GREG",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "0237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010141448",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805804000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "S4117",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BBPT Inc (Body Balance Physical Therapy)
• Monlo Rondon Beck, DPT
• Behavior Strategies
• Jordan Bell, CRNA
• Bennett Healthcare LLC (Bennett Hills Rehabilitation and Care Center)
• Lisa D Boggs, OTRL
• Stephanie Jan Bowles, M.ED,CRC,LPC,NCC
• Marjorie A Brockman, R.N., D.C., C. AC
• Benjamin Don Burtenshaw, PA-C
• Alicia Jean Cardona, PA-C

• Family Medicine Physician in Gooding, ID
• Providers in Gooding, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.