Active NPI
Idaho Urologic Institute PA
- Urology Physician
- Meridian, ID
National Provider Identifier
1689620692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- 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
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807277400 | Medicaid | ID | |
| 8M783 | Other | ID | BLUE CROSS NAMPA |
| DD7372 | Other | ID | RAILROAD MEDICARE |
| 8M152 | Other | ID | BLUE CROSS BOISE |
| 000010006729 | Other | ID | BLUE SHIELD MERIDIAN |
| 000010152026 | Other | ID | BLUE SHIELD NAMPA |
| 8M879 | Other | ID | BLUE CROSS MERIDIAN |
| 000010152026 | Other | ID | BLUE SHIELD BOISE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D0977077 | Idaho Urologic Institute | Compliance | Jan 7, 2027 |
National Provider Directory
National Provider DirectoryMember organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
333 N 1st St
Ste 100
Boise, ID 83702
Phone (208) 343-7736
222 N 2nd St
Ste 115N
Boise, ID 83702
222 N 2nd St
Ste 115
Boise, ID 83702
Phone (208) 336-3232
222 N 2nd St
Ste 125
Boise, ID 83702
1818 S 10th Ave
Ste 240
Caldwell, ID 83605
Phone (208) 377-4000
6195 E Hunt Ave
Nampa, ID 83687
Phone (208) 639-4900
Practitioners & affiliated clinicians
Practitioners 27
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
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": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807277400",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS NAMPA",
"identifier": "8M783",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DD7372",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BOISE",
"identifier": "8M152",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD MERIDIAN",
"identifier": "000010006729",
"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 MERIDIAN",
"identifier": "8M879",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD BOISE",
"identifier": "000010152026",
"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.