Pediatric Neurosurgry of Idaho PC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

M8385 Issued in ID

Legal business name

PEDIATRIC NEUROSURGRY OF IDAHO PC

Practice address

100 E Idaho St
Boise, ID 83712-6270

Phone

(208) 381-7360

Fax

(208) 381-7361

NPI assigned

May 26, 2006

Organization subpart

No

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

Authorized official

Name

Walter Bruce Cherny, MDNPI 1275575839

Title

Owner

Phone

(208) 381-7360

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter Bruce Cherny, MD

  • Neurological Surgery Physician
  • Boise, ID
  • NPI 1275575839
  NPD (past) Authorized official

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211760000000",
    "number": "1750337978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 CURTISIAN AVE",
            "address_2": "SUITE 400",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048880",
            "telephone_number": "208-367-3500",
            "fax_number": "208-367-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126270",
            "telephone_number": "208-381-7360",
            "fax_number": "208-381-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC NEUROSURGRY OF IDAHO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2008-05-26",
        "status": "A",
        "authorized_official_last_name": "CHERNY",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-381-7360",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "ID",
            "license": "M8385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO GROUP",
            "identifier": "8M819",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachael L Pedersen, NP
• Ryan Pedersen, L.AC., D.O.M.
• Elisabeth Pederson, LPC
• Pediatric Cardiology of Idaho
• Pediatric Dentistry Associates
• Pediatric Surgery of Idaho
• Ariane Diola Pedida
• Peer Recovery Supports of Idaho
• Weston Peine, DO
• Alyssa Pekas, MS

• Neurological Surgery Physician in Boise, ID
• Providers in Boise, ID by specialty
• Neurological Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.