Individual provider Active NPI

Caroline Shea Rolofson, DO

  • Obstetrics & Gynecology Physician
  • Boise, ID
National Provider Identifier
1730744988
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
O-1826 Issued in ID
Practice address
100 E Idaho St Ste 302
Boise, ID 83712-6269
Phone
(208) 343-7501
NPI assigned
May 3, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X O-1826 ID Primary

Addresses

Primary practice location

100 E Idaho St Ste 302
Boise, ID 83712-6269

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 343-7501

Other practice location 1

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-5095

Other names 1

  • Caroline Suzanne Shea Former name

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
I20231030003844 ID Practitioner - Obstetrics/Gynecology 9133458417 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
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

100 E Idaho St
Boise, ID 83712-6269

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

333 N 1St St
Suite 110
Boise, ID 83702-6115
Phone (208) 381-3000

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

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

Hospital & facility affiliations

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Obstetrics & Gynecology CurrentSince Sep 18, 2023 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Sep 18, 2023 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

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

100 E Idaho St
Ste 302
Boise, ID 83712
Phone (208) 343-7501

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

Organizations & group practices 4

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 2

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": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1730744988",
    "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",
            "telephone_number": "208-343-7501",
            "fax_number": "208-336-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST STE 302",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126269",
            "telephone_number": "208-343-7501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1638 Owen Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043424",
            "country_code": "US",
            "telephone_number": "910-615-5095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROLOFSON",
        "first_name": "CAROLINE",
        "middle_name": "SHEA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-03",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "O-1826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLINE",
            "last_name": "SHEA",
            "middle_name": "SUZANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.