NPIMap

Organization Active NPI

Digestive Health Clinic LLC

  • Gastroenterology Physician
  • Boise, ID
National Provider Identifier
1750498333
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIGESTIVE HEALTH CLINIC LLC
Practice address
6259 W Emerald St
Boise, ID 83704-8731
Phone
(208) 489-1900
Fax
(208) 375-5286
NPI assigned
Aug 23, 2006
Last updated
Jul 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

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

Authorized official

Name
Mark A Mallory, M.D.NPI 1336116888
Title
Manager
Phone
(208) 489-1900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

6259 W Emerald St
Boise, ID 83704-8731

Mailing address

6259 W Emerald St
Boise, ID 83704-8731
Phone (208) 489-1900

Other identifiers 1

IdentifierTypeStateIssuer
807631700MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070125000398 ID Part B Supplier - Clinic/Group Practice 7315948874 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
Practice locations: Boise, ID; Meridian, ID; Nampa, ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0521878Digestive Health Clinic LLC6259 W Emerald St, Boise, ID 83704ComplianceJan 3, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 33

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.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1750498333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6259 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048731",
            "telephone_number": "208-489-1900",
            "fax_number": "208-375-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6259 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048731",
            "telephone_number": "208-489-1900",
            "fax_number": "208-375-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "MALLORY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-489-1900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807631700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.