NPIMap

Organization Active NPI

Idaho Urologic Institute PA

  • Urology Physician
  • Meridian, ID
National Provider Identifier
1689620692
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
IDAHO UROLOGIC INSTITUTE PA
Practice address
2855 E Magic View Dr
Meridian, ID 83642-6245
Phone
(208) 639-4900
Fax
(208) 639-4939
NPI assigned
May 25, 2006
Last updated
Feb 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Authorized official

Name
Dr. Todd Waldamann, M.D.
Title
Manager
Phone
(208) 343-7736

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

2855 E Magic View Dr
Meridian, ID 83642-6245

Mailing address

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

Other identifiers 8

IdentifierTypeStateIssuer
8M152OtherIDBLUE CROSS BOISE
000010152026OtherIDBLUE SHIELD BOISE
000010152026OtherIDBLUE SHIELD NAMPA
8M783OtherIDBLUE CROSS NAMPA
8M879OtherIDBLUE CROSS MERIDIAN
DD7372OtherIDRAILROAD MEDICARE
000010006729OtherIDBLUE SHIELD MERIDIAN
807277400MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050815000721 ID Part B Supplier - Clinic/Group Practice 9537199039 Receives reassigned benefits from 22 practitioners
Practice locations: Meridian, ID; Mountain Home, ID; Nampa, ID; Boise, ID

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
13D0977077Idaho Urologic Institute2855 E Magic View Dr, Meridian, ID 83642ComplianceJan 7, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

222 N 2nd St
Ste 115
Boise, ID 83702
Phone (208) 336-3232

222 N 2nd St
Ste 115N
Boise, ID 83702

222 N 2nd St
Ste 125
Boise, ID 83702

333 N 1st St
Ste 100
Boise, ID 83702
Phone (208) 343-7736

3090 E Gentry Way
Ste 220
Meridian, ID 83642
Phone (208) 855-0708

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1689620692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO UROLOGIC INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "WALDAMANN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-343-7736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BOISE",
            "identifier": "8M152",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD BOISE",
            "identifier": "000010152026",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NAMPA",
            "identifier": "000010152026",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NAMPA",
            "identifier": "8M783",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MERIDIAN",
            "identifier": "8M879",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD7372",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD MERIDIAN",
            "identifier": "000010006729",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807277400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; 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.