Benjamin Merrill Perry, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

O1145 Issued in ID

Practice address

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442

Phone

(208) 898-7467

Fax

(208) 398-2120

NPI assigned

Jun 12, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, ID2 enrollments

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 2

Specialty

Dermatology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain Pine Dermatology PLLCGroup PAC ID 8729366455, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mountain Pine Dermatology, PLLC

  • Dermatology Physician
  • Meridian, ID
  • NPI 1659827665

  OR

  Medicare reassignment Care Compare group NPD
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1710325758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467",
            "fax_number": "208-398-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467",
            "fax_number": "208-398-2120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1793 13th St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "97302",
            "country_code": "US",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERRY",
        "first_name": "BENJAMIN",
        "middle_name": "MERRILL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "DO168846",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "ID",
            "license": "O1145",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OR",
            "license": "PG163364",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "O1145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Performance and Rehabilitation Chiropractic
• Peripheral Vascular Partners of Boise
• Shelley Kathleen Perkins, M.D.
• Tanya Perkins, COTA/L
• Misa Perron-Burdick, MD
• Katelyn A Perry, LPC
• Sean Perry, DDS
• Stephen Richard Perry, DC
• Denise Peruski, FNP-C
• Kerrie L Petech, R.N. ARNP-CNP

• Dermatology Physician in Meridian, ID
• Providers in Meridian, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; 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.
• 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.