Individual provider Active NPI

Molly F Roy, PA-C

  • Medical Physician Assistant
  • Meridian, ID
National Provider Identifier
1760414023
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-739 Issued in ID
Practice address
2347 E Gala St
Meridian, ID 83642-4881
Phone
(208) 323-3767
Fax
(208) 323-3768
NPI assigned
Jul 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-739 ID Primary

Addresses

Primary practice location

2347 E Gala St
Meridian, ID 83642-4881

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 454-0567

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080725000578 ID Practitioner - Physician Assistant 1052484862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
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)

2347 E Gala St
Meridian, ID 83642-4881
Phone (208) 323-3767

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Aug 29, 2012 Accepting new patients
Nationwide Neuro Health Past Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

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

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

2347 E Gala St
Meridian, ID 83642
Phone (208) 323-0031

Interoperability endpoints

  • Direct secure messaging: mroy16717@direct.slhs.org

Organizations & group practices 3

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357257600000",
    "number": "1760414023",
    "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": "208-454-0567",
            "fax_number": "208-454-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2347 E GALA ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424881",
            "telephone_number": "208-323-3767",
            "fax_number": "208-323-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "MOLLY",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2013-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.