Mountain State Breast & General Surgery PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MOUNTAIN STATE BREAST & GENERAL SURGERY PLLC

Practice address

1525 S Owyhee St
Boise, ID 83705-6014

Phone

(714) 812-5711

NPI assigned

Apr 25, 2023

Last updated

Jan 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rhiana S Menen, MDNPI 1427205160

Title

Owner

Phone

(208) 392-3354

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 4

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.

• Rhiana Shanthi Menen, MD

  • Surgery Physician
  • Boise, ID
  • NPI 1427205160
  Medicare reassignment Care Compare group NPD Authorized official
• Carrie Newton, M.S., D.O.

  • Surgery Physician
  • Boise, ID
  • NPI 1902245764
  Medicare reassignment Care Compare group NPD
• Ashley Cora Rose, FNP

  • Primary Care Nurse Practitioner
  • Boise, ID
  • NPI 1477198190
  Medicare reassignment Care Compare group NPD (past)
• Jay Dean Burrup, PA-C

  • Physician Assistant
  • Meridian, ID
  • NPI 1144504556
  Medicare reassignment

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

{
    "created_epoch": "1682380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1720776164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 S OWYHEE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837056014",
            "telephone_number": "208-392-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 S OWYHEE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837056014",
            "telephone_number": "714-812-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE BREAST & GENERAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-25",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "MENEN",
        "authorized_official_first_name": "RHIANA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-392-3354",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Astrid Moto, LMSW
• Freddy Moto
• Jill Moughamian, NP
• Lakshmi Mouli
• Mountain Creek Medical, LLC, Jennifer Rice Sole MBR (Mountain Creek Medical, LLC)
• Mountain States Counseling & Psychological Services PLLL
• Mountain States Group, Inc
• Mountain States Group, Inc
• Mountain States Group, Inc.
• Mountain States Group, Inc.

• Surgery Physician in Boise, ID
• Providers in Boise, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.