NPIMap

Organization Active NPI

Boise Endoscopy Center, LLC

Doing business as Canyon County Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Nampa, ID
National Provider Identifier
1689332959
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
BOISE ENDOSCOPY CENTER, LLC
Doing business as
Canyon County Endoscopy Center
Practice address
1216 Garrity Blvd
Nampa, ID 83687-3402
Phone
(208) 954-8218
Fax
(208) 368-0863
NPI assigned
Dec 3, 2021
Last updated
Jun 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BOISE ENDOSCOPY CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Rebecca Butterfield
Title
Credentialing Manager
Phone
(208) 489-1431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1216 Garrity Blvd
Nampa, ID 83687-3402

Mailing address

2235 E Gala St
Meridian, ID 83642-8026
Phone (208) 489-1431

Other names 1

  • Canyon County Endoscopy Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220615000580 ID Part B Supplier - Ambulatory Surgical Center 3577580141 Receives reassigned benefits from 15 practitioners
Practice locations: Nampa, ID

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Boise Endoscopy Center LLC Dba Canyon County Endoscopy CenterCCN 13C0001101
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2261113Boise Endoscopy Center Dba1216 Garrity Blvd, Nampa, ID 83687Certificate of waiverMay 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Boise Endoscopy Center LLC4 organizations share this tax ID, including this one
Part of
Boise Endoscopy Center LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

425 W Bannock St
Boise, ID 83702
Phone (208) 343-1702

1206 Garrity Blvd
Nampa, ID 83687

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1689332959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 E GALA ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428026",
            "telephone_number": "208-489-1431",
            "fax_number": "208-343-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 GARRITY BLVD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836873402",
            "telephone_number": "208-954-8218",
            "fax_number": "208-368-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOISE ENDOSCOPY CENTER, LLC",
        "enumeration_date": "2021-12-03",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "BUTTERFIELD",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "208-489-1431"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon County Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Canyon County Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.