Active NPI
Marvin Charles Sparrell, MPAS PA-C
- Surgical Physician Assistant
- Boise, ID
National Provider Identifier
1639181233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA-35
- Practice address
- 500 W Fort St
Boise, ID 83702-4501 - Phone
- (208) 422-1136
- Fax
- (208) 422-1243
- NPI assigned
- Aug 12, 2006
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA-35 | ID | Primary |
Addresses
Primary practice location
500 W Fort St
Boise, ID 83702-4501
Mailing address
110 S Cotterell Dr
Boise, ID 83709-0307
Phone (208) 322-4468
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-35 | ID | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639181233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 S COTTERELL DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837090307",
"telephone_number": "208-322-4468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W FORT ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837024501",
"telephone_number": "208-422-1136",
"fax_number": "208-422-1243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPARRELL",
"first_name": "MARVIN",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MPAS PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "ID",
"license": "PA-35",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.