Individual provider Active NPI

James Lee Burrup, PA

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1659627586
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-991 Issued in ID
Practice address
500 W. Fort St.
# 111
Boise, ID 83702
Phone
(208) 422-1000
Fax
(208) 422-1319
NPI assigned
Jul 30, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-991 ID Primary

Addresses

Primary practice location

500 W. Fort St.
# 111
Boise, ID 83702

Mailing address

13153 W Paint Dr
Boise, ID 83713-1928
Phone (208) 918-2336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-991IDMDPhysician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1659627586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13153 W PAINT DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131928",
            "telephone_number": "208-918-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W. FORT ST.",
            "address_2": "# 111",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURRUP",
        "first_name": "JAMES",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-30",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.