Matthew R Sericati, M.D. Chartered

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

M10669 Issued in ID

Legal business name

MATTHEW R SERICATI, M.D. CHARTERED

Practice address

425 W Bannock St
Boise, ID 83702-6035

Phone

(208) 343-1702

Fax

(208) 342-7042

NPI assigned

May 13, 2011

Last updated

Jul 19, 2019By 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

Dr. Matthew R Sericati, MDNPI 1194871871

Title

President

Phone

(208) 343-1702

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

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.

• Matthew R Sericati, MD

  • Gastroenterology Physician
  • Boise, ID
  • NPI 1194871871
  Authorized official Same address or phone

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

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563494400000",
    "number": "1760774483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026035",
            "telephone_number": "208-343-1702",
            "fax_number": "208-342-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026035",
            "telephone_number": "208-343-1702",
            "fax_number": "208-342-7042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9850 St Lukes Dr",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836877912",
            "country_code": "US",
            "telephone_number": "208-343-6458",
            "fax_number": "208-342-7042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2235 E Gala St",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836428026",
            "country_code": "US",
            "telephone_number": "208-877-3724",
            "fax_number": "208-877-1682",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Garrity Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873402",
            "country_code": "US",
            "telephone_number": "208-343-1702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MATTHEW R SERICATI, M.D. CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2019-07-19",
        "status": "A",
        "authorized_official_last_name": "SERICATI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-343-1702",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ID",
            "license": "M10669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1194871871",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Boise",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Boise",
            "address_1": "425 W Bannock St",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837026035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Gastroenterology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Gastroenterology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; 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.