Individual provider Active NPI

Mary Ann Tuthill, PA

  • Medical Physician Assistant
  • Boise, ID
National Provider Identifier
1720020217
Registry record updated Jan 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-13 Issued in ID
Practice address
6533 W Emerald St
Boise, ID 83704-8737
Phone
(208) 367-4170
Fax
(208) 367-8135
NPI assigned
Jun 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-13 ID Primary

Addresses

Primary practice location

6533 W Emerald St
Boise, ID 83704-8737

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170

Other identifiers 1

IdentifierTypeStateIssuer
001493100MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231113600000",
    "number": "1720020217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048737",
            "telephone_number": "208-367-4170",
            "fax_number": "208-367-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUTHILL",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2009-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-13",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001493100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.