Individual provider Active NPI

Emily Boozalis, MD

  • Dermatology Physician
  • Meridian, ID
National Provider Identifier
1760927990
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M17000 Issued in ID
Practice address
1618 S Millenium Way Ste 100
Meridian, ID 83642-6457
Phone
(208) 884-3376
Fax
(208) 884-0858
NPI assigned
Dec 25, 2016
Last updated
May 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M17000 ID Primary

Addresses

Primary practice location

1618 S Millenium Way Ste 100
Meridian, ID 83642-6457

Mailing address

1618 S Millenium Way Ste 100
Meridian, ID 83642-6457
Phone (208) 884-3376

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address emilyb@adawest.emadirect.md

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230508002076 ID Practitioner - Dermatology 0840655296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Johns Hopkins University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ada West Dermatology, P.C.Group PAC ID 1153341532, 26 clinicians

Practice addresses (Care Compare)

1618 S Millenium Way
Suite 100
Meridian, ID 83642-6457
Phone (208) 884-3376

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.64 of 100Reported as group
Quality
70.07
Promoting interoperability
100
Improvement activities
40
Cost
55.38

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision29
Removal of skin lesions721
Removal or shaving of skin growth1-10
Skin biopsy168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M17000IDMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ada West Dermatology, PC Dermatology CurrentSince May 1, 2023 Accepting new patients
Alan J a Pitt MD P a Dermatology PastSince May 1, 2023 Accepting new patients

Locations

3100 E Barber Valley Dr
Boise, ID 83716
Phone (208) 884-3376

1618 S Millenium Way
Ste 100
Meridian, ID 83642
Phone (208) 884-3376

4574 N Ten Mile Rd
Ste 120
Meridian, ID 83646
Phone (208) 884-3376

Organizations & group practices 2

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.

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": "1482624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1760927990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1618 S MILLENIUM WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426457",
            "telephone_number": "208-884-3376",
            "fax_number": "208-884-0858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 S MILLENIUM WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426457",
            "telephone_number": "208-884-3376",
            "fax_number": "208-884-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOZALIS",
        "first_name": "EMILY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-25",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M17000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emilyb@adawest.emadirect.md",
            "affiliation": "N",
            "address_1": "1618 S Millenium Way Ste 100",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836426457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.