NPIMap

Individual provider Active NPI

Geoffrey Scott Maly, MD, MPH

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1578825022
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MRM-1254 Issued in ID
Practice address
777 N Raymond St
Boise, ID 83704-9251
Phone
(208) 514-2500
Fax
(208) 375-2217
NPI assigned
Jun 11, 2012
Last updated
Jun 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MRM-1254 ID Primary

Addresses

Primary practice location

777 N Raymond St
Boise, ID 83704-9251

Mailing address

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160810000342 OR Practitioner - Family Practice 4981834827 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wallowa County Health Care DistrictGroup PAC ID 4183537566, shared by 7 NPIs, 26 clinicians

Practice addresses (Care Compare)

601 Medical Pkwy
Enterprise, OR 97828-5124

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MRM-1254IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Winding Waters Medical Clinic CurrentSince Sep 13, 2016 Accepting new patients
Wallowa County Health Care District Family Medicine CurrentSince Sep 22, 2016 Accepting new patients
Wallowa County Health Care District Family Medicine CurrentSince Sep 22, 2016 Accepting new patients
Wallowa County Health Care District CurrentSince Jan 1, 2026 Accepting new patients
Winding Waters Medical Clinic CurrentSince Sep 13, 2016 Accepting new patients
Wallowa County Health Care District Past Accepting new patients
Wallowa County Health Care District Family Medicine Past Accepting new patients
Wallowa County Health Care District Past Accepting new patients
Wallowa County Health Care District Family Medicine Past Accepting new patients

Locations

306 W North St
Enterprise, OR 97828
Phone (541) 426-7171

601 Medical Pkwy
Enterprise, OR 97828
Phone (541) 426-3111

603 Medical Pkwy
Enterprise, OR 97828
Phone 54142645025933

Interoperability endpoints

  • Direct secure messaging: gmaly674333@wm.providencedirect.org

Organizations & group practices 9

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466553600000",
    "number": "1578825022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALY",
        "first_name": "GEOFFREY",
        "middle_name": "SCOTT",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-11",
        "last_updated": "2016-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-1254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.