Active NPI
David Deroin, MD
- Family Medicine Physician
- Boise, ID
National Provider Identifier
1609815158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M6079
- Practice address
- 222 N 2ND St
Suite 103
Boise, ID 83702-6109 - Phone
- (208) 342-7722
- NPI assigned
- Jun 6, 2006
- Last updated
- Apr 13, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M6079 | ID | Primary |
Addresses
Primary practice location
222 N 2ND St
Suite 103
Boise, ID 83702-6109
Mailing address
222 N 2ND St
Suite 103
Boise, ID 83702-6109
Phone (208) 342-7722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6079 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apb Medical PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Boise, ID
- NPI 1346428919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239580800000",
"number": "1609815158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N 2ND ST",
"address_2": "SUITE 103",
"city": "BOISE",
"state": "ID",
"postal_code": "837026109",
"telephone_number": "208-342-7722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 N 2ND ST",
"address_2": "SUITE 103",
"city": "BOISE",
"state": "ID",
"postal_code": "837026109",
"telephone_number": "208-342-7722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROIN",
"first_name": "DAVID",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2009-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M6079",
"primary": true
}
],
"identifiers": [],
"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 Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.