Active NPI
Pure Healthcare of Idaho LLC
- Multi-Specialty Clinic/Center
- Boise, ID
National Provider Identifier
1568005809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- PURE HEALTHCARE OF IDAHO LLC
- Practice address
- 5975 W Overland Rd
Boise, ID 83709-3012 - Phone
- (208) 488-4998
- Fax
- (801) 327-0211
- NPI assigned
- Oct 18, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Rachel Fraga
- Title
- Contracting Manager
- Phone
- (801) 921-6325
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
5975 W Overland Rd
Boise, ID 83709-3012
Mailing address
4179 S Riverboat Rd Ste 220
Taylorsville, UT 84123-2986
Phone (801) 755-3387
Other practice location 1
1411 Falls Ave E Ste 1151A
Twin Falls, ID 83301-3455
Phone (208) 543-7995
Other practice location 2
1750 W McMillan Rd Ste 120
Meridian, ID 83646-6891
Phone (208) 900-4480
Other practice location 3
11118 Moss Ln
Nampa, ID 83651-8015
Phone (208) 563-5910
Other practice location 4
916 W Ironwood Dr Ste Ul1
Coeur D Alene, ID 83814-2642
Phone (208) 577-5380
Other practice location 5
3423 Merlin Dr
Idaho Falls, ID 83404-7430
Phone (208) 217-9099
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
6550 W Emerald St
Ste 122
Boise, ID 83704
916 W Ironwood Dr
Ste 3
Coeur D Alene, ID 83814
Phone (208) 577-5380
3423 Merlin Dr
Idaho Falls, ID 83404
Phone (208) 217-9099
1750 W McMillan Rd
Ste 120
Meridian, ID 83646
Phone (208) 900-4480
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Nampa, ID
- NPI 1790931202
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571356800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1746489600000",
"number": "1568005809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4179 S RIVERBOAT RD STE 220",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841232986",
"telephone_number": "801-755-3387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5975 W OVERLAND RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837093012",
"telephone_number": "208-488-4998",
"fax_number": "801-327-0211"
}
],
"practiceLocations": [
{
"address_1": "1411 Falls Ave E Ste 1151A",
"address_purpose": "LOCATION",
"city": "Twin Falls",
"state": "ID",
"postal_code": "833013455",
"country_code": "US",
"telephone_number": "208-543-7995",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1750 W McMillan Rd Ste 120",
"address_purpose": "LOCATION",
"city": "Meridian",
"state": "ID",
"postal_code": "836466891",
"country_code": "US",
"telephone_number": "208-900-4480",
"fax_number": "801-327-0211",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11118 Moss Ln",
"address_purpose": "LOCATION",
"city": "Nampa",
"state": "ID",
"postal_code": "836518015",
"country_code": "US",
"telephone_number": "208-563-5910",
"fax_number": "801-327-0211",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "916 W Ironwood Dr Ste Ul1",
"address_purpose": "LOCATION",
"city": "Coeur D Alene",
"state": "ID",
"postal_code": "838142642",
"country_code": "US",
"telephone_number": "208-577-5380",
"fax_number": "801-327-0211",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3423 Merlin Dr",
"address_purpose": "LOCATION",
"city": "Idaho Falls",
"state": "ID",
"postal_code": "834047430",
"country_code": "US",
"telephone_number": "208-217-9099",
"fax_number": "801-327-0211",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PURE HEALTHCARE OF IDAHO LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-10-18",
"last_updated": "2025-05-06",
"certification_date": "2025-05-06",
"status": "A",
"authorized_official_last_name": "FRAGA",
"authorized_official_first_name": "RACHEL",
"authorized_official_title_or_position": "CONTRACTING MANAGER",
"authorized_official_telephone_number": "801-921-6325"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"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 May 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.