NPIMap

Individual provider Active NPI

Christopher C Wyatt, MD

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Boise, ID
National Provider Identifier
1649487430
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
License
M-10687 Issued in ID
Practice address
1055 N Curtis Road
S6
Boise, ID 83706
Phone
(208) 302-0800
Fax
(208) 302-0855
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M-10687 ID
Emergency Medicine Physician 207P00000X R-7842 IA
Emergency Medicine Physician 207P00000X MD183860 OR
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X M-10687 ID Primary

Addresses

Primary practice location

1055 N Curtis Road
S6
Boise, ID 83706

Mailing address

3340 E Goldstone Way
Meridian, ID 83642
Phone (208) 302-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090723000328 ID Practitioner - Emergency MedicinePractitioner - Undersea and Hyperbaric Medicine 7416009345 Reassigns benefits to 1 organization
I20170921001208 OR Practitioner - Emergency Medicine 7416009345 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 SW 3Rd Ave
Suite 1600
Ontario, OR 97914-4552
Phone (541) 881-2360

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

3025 W Cherry LN
Meridian, ID 83642-8531

4400 E Flamingo Ave
Nampa, ID 83687-9203

4402 E Flamingo Ave
Nampa, ID 83687-9203
Phone (208) 288-4520

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue86
Removal of skin lesions12
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-7842IAMDEmergency Medicine Physician
M-10687IDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince May 1, 2018 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Oct 3, 2018 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince May 1, 2018 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Oct 3, 2018 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Oct 3, 2017 Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1055 N Curtis Rd
#S6
Boise, ID 83706
Phone (208) 302-0800

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

645 E 5th St
Weiser, ID 83672
Phone (208) 549-0370

1050 SW 3rd Ave
Ste 1600
Ontario, OR 97914
Phone (541) 881-2360

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

Organizations & group practices 6

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 9

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": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1649487430",
    "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": "208-302-0800",
            "fax_number": "208-302-0855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS ROAD",
            "address_2": "S6",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83706",
            "telephone_number": "208-302-0800",
            "fax_number": "208-302-0855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "CHRISTOPHER",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-10687",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "R-7842",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD183860",
            "primary": false
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "ID",
            "license": "M-10687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.