Individual provider Active NPI

Susan M Marzolf, M.D.

  • Obstetrics & Gynecology Physician
  • Twin Falls, ID
National Provider Identifier
1568447019
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
M-7035 Issued in ID
Practice address
801 Pole Line Rd W Ste 3880
Twin Falls, ID 83301-5811
Phone
(208) 814-8500
NPI assigned
Dec 7, 2005
Last updated
Oct 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 33703 AZ
Obstetrics & Gynecology Physician 207V00000X M-7035 ID Primary

Addresses

Primary practice location

801 Pole Line Rd W Ste 3880
Twin Falls, ID 83301-5811

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other identifiers 3

IdentifierTypeStateIssuer
86080015085259C424OtherAZTRIWEST
P00251227OtherAZRAILROAD MEDICARE
916455MedicaidAZ

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130521000141 ID Practitioner - Obstetrics/Gynecology 3375596034 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33703AZMDObstetrics & Gynecology Physician
M-7035IDMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Obstetrics & Gynecology CurrentSince Mar 31, 2013 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Mar 31, 2013 Accepting new patients
St Luke's Clinic LLC CurrentSince Oct 20, 2022 Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD PastSince Oct 23, 2022 Accepting new patients

Locations

100 E Idaho St
Ste 400
Boise, ID 83712
Phone (208) 345-5250

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

520 S Eagle Rd
Ste 3209
Meridian, ID 83642
Phone (208) 345-5250

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

801 Pole Line Rd W
Ste 3880
Twin Falls, ID 83301
Phone (208) 814-8500

Interoperability endpoints

  • Direct secure messaging: smarzolf295120@direct.ochin.org
  • Direct secure messaging: smarzolf31972@direct.slhs.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1568447019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 POLE LINE RD W STE 3880",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015811",
            "telephone_number": "208-814-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARZOLF",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-07",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "33703",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "M-7035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "86080015085259C424",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00251227",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916455",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.