Active NPI
Frank J Fazzio Jr., M.D.
- Surgery Physician
- Boise, ID
National Provider Identifier
1528035276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- M3382
- Practice address
- 7301 W Emerald St
Ste 102
Boise, ID 83704-8688 - Phone
- (208) 321-8600
- Fax
- (208) 321-8626
- NPI assigned
- Mar 1, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M3382 | ID | Primary |
Addresses
Primary practice location
7301 W Emerald St
Ste 102
Boise, ID 83704-8688
Mailing address
7301 W Emerald St
Ste 102
Boise, ID 83704-8688
Phone (208) 321-8600
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528035276 | Other | ID | NPI |
| 020051465 | Other | ID | RAILROAD MEDICARE |
| 204186533 | Other | ID | TAX ID |
| 57851 | Other | ID | BLUE CROSS |
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 |
|---|---|---|---|
| M3382 | ID | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fazzio Clinic PC | Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277856000000",
"number": "1528035276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7301 W EMERALD ST",
"address_2": "STE 102",
"city": "BOISE",
"state": "ID",
"postal_code": "837048688",
"telephone_number": "208-321-8600",
"fax_number": "208-321-8626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7301 W EMERALD ST",
"address_2": "STE 102",
"city": "BOISE",
"state": "ID",
"postal_code": "837048688",
"telephone_number": "208-321-8600",
"fax_number": "208-321-8626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZZIO",
"first_name": "FRANK",
"middle_name": "J",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-01",
"last_updated": "2010-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M3382",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1528035276",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020051465",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "204186533",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "57851",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}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 Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.