NPIMap

Organization Active NPI

Mountain States Medical Group PA

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1730272006
Registry record updated Sep 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOUNTAIN STATES MEDICAL GROUP PA
Practice address
4809 Fairview Avenue
Boise, ID 83706-2242
Phone
(208) 378-2840
Fax
(208) 323-9070
NPI assigned
Oct 1, 2006
Last updated
Sep 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2008

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

Authorized official

Name
Richard McChrystal, PANPI 1659464923
Title
President
Phone
(208) 378-2840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4809 Fairview Avenue
Boise, ID 83706-2242

Mailing address

PO Box 4236
Boise, ID 83711-4236
Phone (208) 378-2840

Other identifiers 2

IdentifierTypeStateIssuer
8C196OtherIDBLUE CROSS
000010017966OtherIDRBSI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1159660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221436800000",
    "number": "1730272006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4236",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837114236",
            "telephone_number": "208-378-2840",
            "fax_number": "208-323-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4809 FAIRVIEW AVENUE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062242",
            "telephone_number": "208-378-2840",
            "fax_number": "208-323-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-01",
        "last_updated": "2008-09-15",
        "status": "A",
        "authorized_official_last_name": "MCCHRYSTAL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-378-2840",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8C196",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RBSI",
            "identifier": "000010017966",
            "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 Sep 15, 2008; 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.