Justin Michael Nelson

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MRM-2235 Issued in ID

Practice address

500 W Fort St # 111R
Boise, ID 83702-4599

Phone

(208) 422-1314

Fax

(208) 422-1388

NPI assigned

Mar 20, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1700588407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W FORT ST # 111R",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W FORT ST # 111R",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024599",
            "telephone_number": "208-422-1314",
            "fax_number": "208-422-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JUSTIN",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "MRM-2235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis W Nelson, PHARMD
• Dianne Denise Nelson, PT
• Eric Nelson, RN
• Eric Webb Nelson, MD, DDS
• Jayne Nelson, PA-C
• Kinsey Elora Nelson, LPC
• Kristi Nelson, MA
• Lisa M Nelson, M.D.
• Matthew Alex Nelson, LMT, CMA, MFA
• Matthew Jacob Nelson, MD

• Internal Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Internal Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.