Meredith Mangum, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP-1579A Issued in ID

Practice address

608 S Phillippi St
Boise, ID 83705-1160

Phone

(208) 580-8888

NPI assigned

Jul 9, 2015

Last updated

Sep 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mangum Primary Care LLCGroup PAC ID 0547706509, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mangum Primary Care LLC

  • Primary Care Clinic/Center
  • Boise, ID
  • NPI 1194494229
  Medicare reassignment Care Compare group NPD Authorized official
• David J Butuk MD PA

  dba Meridian Family Medicine

  • Family Medicine Physician
  • Meridian, ID
  • NPI 1710174800
  Medicare reassignment NPD

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1740663657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 S PHILLIPPI ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837051160",
            "telephone_number": "208-580-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 S PHILLIPPI ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837051160",
            "telephone_number": "208-580-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "MEREDITH",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-09",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1579A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "NP-1579A",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert S Mancini, PHARM.D.
• Nathan Mandigo, ABT, CMT
• Nicholas Manfredo, MS, LPC
• Mangum Primary Care LLC
• Karen Mangum, M.S., R.D.N., L.D.
• Ryan Mangum, PHD
• Christopher Scott Manis Jr., DMD
• Marc Manko, PA-C
• Katherine Elizabeth Mankus, PA-C
• Chelsea Mannebach, PHARM.D.

• Family Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.