NPIMap

Individual provider Active NPI

Laura Tedrick, M.D.

  • Obstetrics & Gynecology Physician
  • Boise, ID
National Provider Identifier
1528453552
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
M-14695 Issued in ID
Practice address
1072 N Liberty St Ste 100
Boise, ID 83704-8708
Phone
(208) 302-1200
Fax
(208) 302-1255
NPI assigned
Apr 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X M-14695 ID Primary

Addresses

Primary practice location

1072 N Liberty St Ste 100
Boise, ID 83704-8708

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

Msc 10 5580
1 University of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-4051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190913001723 ID Practitioner - Obstetrics/Gynecology 7517271984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Washington School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

1072 N Liberty St
Boise, ID 83704-8708

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-14695IDMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Idaho Health Partners LLC CurrentSince May 2, 2022 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince May 1, 2024 Accepting new patients
Women'S Health Associates, PLLC Obstetrics & Gynecology CurrentSince Aug 1, 2019 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince May 1, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
OB-GYN Associates, PA Obstetrics & Gynecology PastSince Feb 1, 2016 Accepting new patients
T-Medica Mobil Anesthesia Inc. PastSince Apr 17, 2022 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

333 N 1st St
Ste 240
Boise, ID 83702
Phone (208) 338-8900

1072 N Liberty St
Ste 100
Boise, ID 83704
Phone (208) 302-1200

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

9850 W St Lukes Dr
Ste 129
Nampa, ID 83687
Phone (208) 205-7600

215 E Hawaii Ave
Nampa, ID 83686
Phone (208) 463-3234

Interoperability endpoints

  • Direct secure messaging: ltedrick3442202@direct.trinity-health.org

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1528453552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 N LIBERTY ST STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048708",
            "telephone_number": "208-302-1200",
            "fax_number": "208-302-1255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Msc 10 5580",
            "address_2": "1 University of New Mexico",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871310001",
            "country_code": "US",
            "telephone_number": "505-272-4051",
            "fax_number": "505-272-6385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEDRICK",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-06",
        "last_updated": "2024-03-20",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "M-14695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.