NPIMap

Organization Active NPI

David J Butuk MD PA

Doing business as Meridian Family Medicine

  • Family Medicine Physician
  • Meridian, ID
National Provider Identifier
1710174800
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DAVID J BUTUK MD PA
Doing business as
Meridian Family Medicine
Practice address
1525 E Leighfield Dr
Suite 150
Meridian, ID 83646-5371
Phone
(208) 888-1199
Fax
(208) 888-0807
NPI assigned
Oct 2, 2007
Last updated
Oct 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
David J Butuk, M.D.NPI 1942250972
Title
Owner
Phone
(208) 888-1199

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1525 E Leighfield Dr
Suite 150
Meridian, ID 83646-5371

Mailing address

PO Box 44440
Boise, ID 83711-0440
Phone (208) 888-1199

Other identifiers 1

IdentifierTypeStateIssuer
806698100MedicaidID

Other names 1

  • MERIDIAN FAMILY MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040211001072 ID Part B Supplier - Clinic/Group Practice 5698669422 Receives reassigned benefits from 7 practitioners
Practice locations: Meridian, ID

National Provider Directory

National Provider Directory

Locations

1525 E Leigh Field Dr
Ste 150
Meridian, ID 83646
Phone (208) 888-1199

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1710174800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44440",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837110440",
            "telephone_number": "208-888-1199",
            "fax_number": "208-888-0807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E LEIGHFIELD DR",
            "address_2": "SUITE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465371",
            "telephone_number": "208-888-1199",
            "fax_number": "208-888-0807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID J BUTUK MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "BUTUK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-888-1199",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806698100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERIDIAN FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.