Complete Care Audiology Inc.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

H412 Issued in ID

Legal business name

COMPLETE CARE AUDIOLOGY INC.

Doing business as

Boise Speech and Hearing Clinic

Practice address

13176 Persimmon LN
# 120
Boise, ID 83713-1986

Phone

(208) 376-3591

Fax

(208) 376-3594

NPI assigned

May 25, 2006

Last updated

Apr 2, 2008By 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

Brek D Stoker, AUD CCCANPI 1609822402

Title

Owner

Phone

(208) 376-3591

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Boise Speech and Hearing Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 2

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.

• Brek David Stoker, AUD, CCC-A

  • Specialist
  • Boise, ID
  • NPI 1609822402
  Medicare reassignment Care Compare group NPD Authorized official
• Jenna Marie Bradley, AU.D.

  • Audiologist
  • Boise, ID
  • NPI 1871279240
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1770539694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13176 PERSIMMON LN",
            "address_2": "# 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-376-3591",
            "fax_number": "208-376-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13176 PERSIMMON LN",
            "address_2": "# 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-376-3591",
            "fax_number": "208-376-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE AUDIOLOGY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "STOKER",
        "authorized_official_first_name": "BREK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-376-3591",
        "authorized_official_credential": "AUD CCCA"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "ID",
            "license": "H412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010143633",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "AU191",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boise Speech and Hearing Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Audiologist in Boise, ID
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.