Tish D Davis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1576 Issued in ID

Practice address

2235 E Gala St
Meridian, ID 83642-8026

Phone

(208) 887-3724

Fax

(208) 887-1682

NPI assigned

Jun 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Gastroenterology Associates LLPGroup PAC ID 6002708773, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke's Regional Medical Center Hospital, Boise, ID, CCN 130006
• St Luke's Nampa Medical Center Hospital, Nampa, ID, CCN 130071

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tishdavis@igallp.allscriptsdirect.net

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.

• Idaho Gastroenterology Associates, LLP

  • Gastroenterology Physician
  • Boise, ID
  • NPI 1265427256
  Medicare reassignment Care Compare group
• Southern Idaho Health Partners LLC

  dba Saltzer Clinics

  • General Practice Physician
  • Meridian, ID
  • NPI 1952701401
  NPD (past)

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

• St Lukes Regional Medical Center

  dba Air St Luke's

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation
• St Lukes West LTD

  dba St Lukes Nampa Medical Center

  • General Acute Care Hospital
  • Nampa, ID
  • NPI 1831590660
  Care Compare affiliation

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1548201007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026035",
            "telephone_number": "208-343-1702",
            "fax_number": "208-342-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 E GALA ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428026",
            "telephone_number": "208-887-3724",
            "fax_number": "208-887-1682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 W Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026035",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-343-5031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9850 St Lukes Dr",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836877912",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-343-5031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Garrity Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873402",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-343-5031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TISH",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA1576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Boise",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Boise",
            "address_1": "425 W Bannock St",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837026035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Davis, PHARMD
• Kerry Davis
• Leslie Anne Davis, D.C.
• Mishayla Kassidy Davis
• Stephanie M Davis
• Toby A Davis, DO
• Rikki M Davlin, LCSW
• Dawn's Legacy LLC
• Jill K Dawson, NP
• Karen Lea Dawson

• Medical Physician Assistant in Meridian, ID
• Providers in Meridian, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.