Individual provider Active NPI

Kenneth Verlage

  • Urology Physician
  • Boise, ID
National Provider Identifier
1730620907
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
M-17493 Issued in ID
Practice address
510 N 2ND St Ste 102
Boise, ID 83702-6077
Phone
(208) 381-4700
NPI assigned
Mar 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X M-17493 ID Primary
Urology Physician 208800000X MD210158 OR

Addresses

Primary practice location

510 N 2ND St Ste 102
Boise, ID 83702-6077

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

501 N Graham St Ste 420
Portland, OR 97227-2006
Phone (503) 288-7303

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address referringaua@orclinic.direct-ci.net Oregon Clinic PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20231220001825 ID Practitioner - Urology 1658645015 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Texas Tech University Health Science Center School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

510 N 2ND St
Suite 103
Boise, ID 83702-6081
Phone (208) 381-4700

520 S Eagle Rd
Meridian, ID 83642-6351

520 S Eagle Rd
Meridian, ID 83642-6352

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

9580 W St Lukes Dr
Nampa, ID 83687-7912
Phone (208) 505-2711

9850 St Lukes Dr
Nampa, ID 83687-7912

9850 W St Luke'S Dr
Nampa, ID 83687-7912

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S Elmore Medical Center Hospital, Mountain Home, ID, CCN 131311
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
  • St Luke'S McCall Hospital, McCall, ID, CCN 131312

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-17493IDMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Nov 7, 2023 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

520 S Eagle Rd
Ste 3112
Meridian, ID 83642
Phone (208) 706-5800

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1730620907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N 2ND ST STE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026077",
            "telephone_number": "208-381-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 N Graham St Ste 420",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972272006",
            "country_code": "US",
            "telephone_number": "503-288-7303",
            "fax_number": "503-288-3806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERLAGE",
        "first_name": "KENNETH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "M-17493",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "MD210158",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referringaua@orclinic.direct-ci.net",
            "affiliation": "Y",
            "affiliationName": "Oregon Clinic PC",
            "address_1": "501 N Graham St Ste 420",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972272006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.