Michael J. Tullis, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

M-7939 Issued in ID

Practice address

3875 E Overland Rd Ste 2D
Meridian, ID 83642-9005

Phone

(208) 600-1550

Fax

(208) 600-1551

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  NPD

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1598717985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3875 E OVERLAND RD STE 2D",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429005",
            "telephone_number": "208-600-1550",
            "fax_number": "208-600-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 E OVERLAND RD STE 2D",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429005",
            "telephone_number": "208-600-1550",
            "fax_number": "208-600-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLIS",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ID",
            "license": "M-7939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288349",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010028313",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805714900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "J3938",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "770002414",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy J Tucker, LPC
• Sarah Tucker
• Sonya Tucker
• Morgan Anne Jenson Tueller
• Matthew L Tuft, DDS
• Savanna Turk
• Amber N Turner, DO
• Charles Gene Turner, PA-C
• Kai Lamont Turner, PT, DPT, CSCS
• Mark Alan Turner, MD

• Vascular Surgery Physician in Meridian, ID
• Providers in Meridian, ID by specialty
• Vascular Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.