Boise Radiology Group PLLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

BOISE RADIOLOGY GROUP PLLC

Practice address

620 W Hays St
Boise, ID 83702-5511

Phone

(208) 381-2094

Fax

(208) 381-1791

NPI assigned

Jun 25, 2006

Last updated

Mar 4, 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

Ms. Lisa Smith

Title

Administrator

Phone

(208) 433-9466

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, PA, WA, UT, AZ, CA, KS, IL, CT, NC, TN11 enrollments

Enrollment records 11

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Sawtooth Diagnostic Imaging PLLC

  • Vascular & Interventional Radiology Physician
  • Ketchum, ID
  • NPI 1396792305

  Member Of

  NPD member

Locations

Practitioners 87

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.

• Shane K Ball, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1679500557
  Medicare reassignment Care Compare group NPD
• Cody J. Boyce, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1508816471
  Medicare reassignment Care Compare group NPD
• Elias David Elkas Calkins

  • Diagnostic Radiology Physician
  • Meridian, ID
  • NPI 1063973345
  Medicare reassignment Care Compare group NPD
• Sean M Carr, M.D.

  • Vascular & Interventional Radiology Physician
  • Boise, ID
  • NPI 1851335509

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Michael David Carroll, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1639306566
  Medicare reassignment Care Compare group NPD
• Stephanie Frances Cheng, MD

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1356665285

  WA

  Medicare reassignment Care Compare group NPD
• Elaine N Daniel, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1720024094
  Medicare reassignment Care Compare group NPD
• Geoffry De Gennaro Jr., M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1336554740
  Medicare reassignment Care Compare group NPD
• Quinn A Demordaunt, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1750323226
  Medicare reassignment Care Compare group NPD
• Daniel Jackson Dickman, D.O.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1902256548
  Medicare reassignment Care Compare group NPD
• Michael T Fisher, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1134155229
  Medicare reassignment Care Compare group NPD
• Michael A Fuchs, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1588692289
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1740216175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1616",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477060018",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W HAYS ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025511",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE RADIOLOGY GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-433-9466",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Boise Premier Dentistry
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• Boise Rheumatology PC
• Boise River Counseling
• Boise Services Group, Inc. (Ready Set Go)
• Boise SH, LLC
• Boise Skin Clinic PLLC

• Diagnostic Radiology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Diagnostic Radiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.