NPIMap

Individual provider Active NPI

Ryan Lewis Van de Graaff, MD

  • Otolaryngology Physician
  • Boise, ID
National Provider Identifier
1619067436
Registry record updated Jun 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
M-10288 Issued in ID
Practice address
900 N Liberty St.
Ste 400
Boise, ID 83704
Phone
(208) 367-3320
Fax
(208) 367-7474
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 22476 NE
Otolaryngology Physician 207Y00000X M-10288 ID Primary

Addresses

Primary practice location

900 N Liberty St.
Ste 400
Boise, ID 83704

Mailing address

900 N. Liberty St.
Ste 400
Boise, ID 83704
Phone (208) 367-3320

Other identifiers 1

IdentifierTypeStateIssuer
808096700MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20080814000156 ID Practitioner - Otolaryngology 8527133297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Utah School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

900 N Liberty St
Suite 400
Boise, ID 83704-8707
Phone (208) 336-4368

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.94 of 100Reported as group
Quality
63.68
Improvement activities
40
Cost
68.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-10288IDMDOtolaryngology Physician
22476NEMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Idaho Ear, Nose and Throat Otolaryngology CurrentSince Aug 11, 2008 Accepting new patients
Southwest Idaho Ear, Nose and Throat, PA Otolaryngology Current Accepting new patients

Locations

900 N Liberty St
Ste 450
Boise, ID 83704
Phone (208) 367-7431

900 N Liberty St
Boise, ID 83704
Phone (208) 367-2229

900 N Liberty St
Ste 400
Boise, ID 83704
Phone (208) 336-4368

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DEAGCD

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275350400000",
    "number": "1619067436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N. LIBERTY ST.",
            "address_2": "STE 400",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-367-3320",
            "fax_number": "208-367-7474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N LIBERTY ST.",
            "address_2": "STE 400",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-367-3320",
            "fax_number": "208-367-7474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE GRAAFF",
        "first_name": "RYAN",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2010-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NE",
            "license": "22476",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ID",
            "license": "M-10288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808096700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.