Idaho Surgical Partners, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

M6834 Issued in ID

Legal business name

IDAHO SURGICAL PARTNERS, PC

Practice address

323 E Riverside Dr Ste 220
Eagle, ID 83616-5246

Phone

(208) 343-5600

NPI assigned

Jan 18, 2007

Last updated

Sep 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ami Yantis

Title

Administrator

Phone

(208) 649-8347

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew R Macha, MD

  • Surgery Physician
  • Eagle, ID
  • NPI 1730190836
  Medicare reassignment

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1598817348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2045",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836169110",
            "telephone_number": "208-343-5600",
            "fax_number": "208-779-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E RIVERSIDE DR STE 220",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165246",
            "telephone_number": "208-343-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "166 W Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026124",
            "country_code": "US",
            "telephone_number": "208-343-5600",
            "fax_number": "208-345-4398",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1906 Fairview Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836055433",
            "country_code": "US",
            "telephone_number": "208-343-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IDAHO SURGICAL PARTNERS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "YANTIS",
        "authorized_official_first_name": "AMI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-649-8347"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M6834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002779400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807305800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idaho Massage LLC
• Idaho Massage LLC
• Idaho Nutrition Associates, LLC
• Idaho Pain Associates PLLC
• Idaho Pharmacy LLC
• Idealspine Health Center
• Faith Ihli
• Cary Imeson, LCSW
• Intermountain Eye and Laser Centers PLLC (Intermountain Eye Centers)
• Intermountain Medical Imaging LLC

• Specialist in Eagle, ID
• Providers in Eagle, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; 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.

Verify at the official NPI Registry.