Individual provider Active NPI

Madison Shae Ford, RD

  • Registered Dietitian
  • Boise, ID
National Provider Identifier
1689373235
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
D-1449 Issued in ID
Practice address
305 E Jefferson St
Boise, ID 83712-6231
Phone
(208) 381-7081
NPI assigned
Mar 2, 2023
Last updated
May 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X D-1449 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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D-1449IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Regional Medical Center Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1689373235",
    "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": "208-381-7081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 E Bannock St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837126241",
            "country_code": "US",
            "telephone_number": "208-381-2222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORD",
        "first_name": "MADISON",
        "middle_name": "SHAE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-02",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-1449",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.