NPIMap

Individual provider Active NPI

Phatama Padavanija, MD

  • Medical Oncology Physician
  • Twin Falls, ID
National Provider Identifier
1679527717
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
M-11228 Issued in ID
Practice address
725 Pole Line Rd W
Twin Falls, ID 83301-5800
Phone
(208) 814-1600
NPI assigned
May 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 17531 AL
Medical Oncology Physician 207RX0202X M-11228 ID Primary

Addresses

Primary practice location

725 Pole Line Rd W
Twin Falls, ID 83301-5800

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222

Other identifiers 3

IdentifierTypeStateIssuer
009997775MedicaidAL
009997765MedicaidAL
009998765MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110406000816 ID Practitioner - Medical Oncology 2567417215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
University of South Alabama College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

725 Pole Line Rd W
Twin Falls, ID 83301-5860
Phone (208) 814-1600

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
  • St Luke'S Wood River Medical Center Hospital, Ketchum, ID, CCN 131323
  • St Luke'S Jerome Hospital, Jerome, ID, CCN 131310
  • Minidoka Memorial Hospital Hospital, Rupert, ID, CCN 131319

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17531ALMDHematology & Oncology Physician
M-11228IDMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Hematology & Oncology CurrentSince Mar 1, 2012 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

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

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

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

725 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1600

Interoperability endpoints

  • Direct secure messaging: ppadavanija32335@direct.slhs.org

Organizations & group practices 2

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 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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407110400000",
    "number": "1679527717",
    "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",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 POLE LINE RD W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015800",
            "telephone_number": "208-814-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADAVANIJA",
        "first_name": "PHATAMA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-22",
        "last_updated": "2014-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AL",
            "license": "17531",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "ID",
            "license": "M-11228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009997775",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009997765",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009998765",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.