Active NPI
Darrell J Ludders, MD
- Obstetrics & Gynecology Physician
- Boise, ID
National Provider Identifier
1548214927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- M3180
- Practice address
- 1072 N Liberty St
Suite 100
Boise, ID 83704-8708 - Phone
- (208) 367-4321
- Fax
- (208) 367-4525
- NPI assigned
- May 20, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | M3180 | ID | Primary |
Addresses
Primary practice location
1072 N Liberty St
Suite 100
Boise, ID 83704-8708
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010159518 | Other | ID | BLUE SHIELD |
| B5711 | Other | ID | BLUE CROSS |
| 003801000 | 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 |
|---|---|---|---|
| M3180 | ID | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Alphonsus Regional Medical Center Inc | 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.
-
- Psychiatric Hospital Unit
- Boise, ID
- NPI 1770687857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371600000000",
"number": "1548214927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421026",
"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",
"address_2": "SUITE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "837048708",
"telephone_number": "208-367-4321",
"fax_number": "208-367-4525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUDDERS",
"first_name": "DARRELL",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-20",
"last_updated": "2013-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "ID",
"license": "M3180",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010159518",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "B5711",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003801000",
"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 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.