Active NPI
Michael J Trimble, PA-C
- Physician Assistant
- Boise, ID
National Provider Identifier
1649235581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-1602
- Practice address
- 6165 W Emerald Street
Boise, ID 83704 - Phone
- (208) 302-3500
- Fax
- (208) 302-3555
- NPI assigned
- Apr 20, 2006
- Last updated
- May 22, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-1602 | ID | Primary |
| Physician Assistant | 363A00000X | 757 | CO |
Addresses
Primary practice location
6165 W Emerald Street
Boise, ID 83704
Mailing address
3340 E Goldstone Way
Meridian, ID 83642
Phone (208) 302-3500
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 757 | CO | MD | Physician Assistant |
| PA-1602 | ID | MD | Physician Assistant |
Interoperability endpoints
- mtrimble1564353@direct.trinity-health.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526947200000",
"number": "1649235581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "83642",
"telephone_number": "208-302-3500",
"fax_number": "208-302-3555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6165 W EMERALD STREET",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-302-3500",
"fax_number": "208-302-3555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRIMBLE",
"first_name": "MICHAEL",
"middle_name": "J",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2018-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-1602",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "757",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.