NPIMap

Individual provider Active NPI

John P Goeddertz, CRNA

  • Certified Registered Nurse Anesthetist
  • Boise, ID
National Provider Identifier
1659424125
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RNA-694 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-2163
NPI assigned
Jan 19, 2007
Last updated
Oct 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R26650 ND
Certified Registered Nurse Anesthetist 367500000X RNA-694 ID Primary

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 302-9342

Other identifiers 1

IdentifierTypeStateIssuer
12462MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070910000754 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 8921025735 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Consultants of Treasure Valley PLLCGroup PAC ID 4981661196, 27 clinicians

Practice addresses (Care Compare)

8800 W Emerald St
Boise, ID 83704-8205
Phone (208) 373-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Consultants of Treasure Valley PLLC CurrentSince Jan 7, 2019 Accepting new patients
St Alphonsus Professional Medical Services LLC CurrentSince Nov 1, 2023 Accepting new patients
St Alphonsus Professional Medical Services LLC CurrentSince Nov 1, 2023 Accepting new patients
Boise Anesthesia, P a Nurse Anesthetist, Certified Registered CurrentSince Jun 16, 2016 Accepting new patients
St. Alexius Heart & Lung Clinic, LLC Past Accepting new patients
St Alexius Same Day Surgery Center Past Accepting new patients

Locations

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

8800 W Emerald St
Boise, ID 83704
Phone (208) 373-5000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1659424125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-302-9342",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEDDERTZ",
        "first_name": "JOHN",
        "middle_name": "P",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R26650",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "RNA-694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12462",
            "state": "ND"
        }
    ],
    "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 Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.