NPIMap

Organization Active NPI

James a. Gorczyca DDS PA

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1568622876
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-1672 Issued in ID
Legal business name
JAMES A. GORCZYCA DDS PA
Practice address
144 E Mallard Dr
Boise, ID 83706-3975
Phone
(208) 342-0315
NPI assigned
Jun 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

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

Authorized official

Name
Shelley Fannin
Title
Accounts Manager
Phone
(208) 342-0315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D-1672 ID Primary

Addresses

Primary practice location

144 E Mallard Dr
Boise, ID 83706-3975

Mailing address

144 E Mallard Dr
Boise, ID 83706-3975
Phone (208) 342-0315

Other identifiers 1

IdentifierTypeStateIssuer
002485600MedicaidID

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1568622876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 E MALLARD DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063975",
            "telephone_number": "208-342-0315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 E MALLARD DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063975",
            "telephone_number": "208-342-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES A. GORCZYCA DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "FANNIN",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "208-342-0315"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002485600",
            "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 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.