Individual provider Active NPI

John Stephen Collier, M.D.

  • Pediatric Gastroenterology Physician
  • Boise, ID
National Provider Identifier
1659729903
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
M-16895 Issued in ID
Practice address
305 E Jefferson St
Boise, ID 83712-6231
Phone
(208) 381-7310
NPI assigned
May 27, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 11018763A IN
Pediatric Gastroenterology Physician 2080P0206X 11262373-1205 UT
Pediatric Gastroenterology Physician 2080P0206X M-16895 ID Primary

Addresses

Primary practice location

305 E Jefferson St
Boise, ID 83712-6231

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

705 Riley Hospital Dr
Room 5867
Indianapolis, IN 46202-5109
Phone (317) 948-7571

Other practice location 2

81 N Mario Capecchi Dr
Salt Lake City, UT 84113-1125
Phone (801) 213-3599

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230116000081 ID Practitioner - Pediatric Medicine 9133419153 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11262373-1205UTMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Pediatrics CurrentSince Nov 17, 2022 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Pediatrics CurrentSince Nov 17, 2022 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
University Pediatric Associates, Inc. Pediatrics Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

305 E Jefferson St
Boise, ID 83712
Phone (208) 345-0715

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1659729903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E JEFFERSON ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126231",
            "telephone_number": "208-381-7310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Riley Hospital Dr",
            "address_2": "Room 5867",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-948-7571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "81 N Mario Capecchi Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841131125",
            "country_code": "US",
            "telephone_number": "801-213-3599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLIER",
        "first_name": "JOHN",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-27",
        "last_updated": "2022-11-17",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "11018763A",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "UT",
            "license": "11262373-1205",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "ID",
            "license": "M-16895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.