Individual provider Active NPI

Roger Keith Ottman, MD

  • Emergency Medicine Physician
  • Nampa, ID
National Provider Identifier
1790705283
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
M-3812 Issued in ID
Practice address
1512 12TH Ave Rd
Nampa, ID 83686-6008
Phone
(208) 463-5100
NPI assigned
Jul 20, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M-3812 ID Primary

Addresses

Primary practice location

1512 12TH Ave Rd
Nampa, ID 83686-6008

Mailing address

1100 River Heights Dr
Meridian, ID 83642-5166
Phone (208) 841-1814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120222000083 AZ Practitioner - Emergency Medicine 9133158710 Reassigns benefits to 2 organizations
I20190924002914 TX Practitioner - Emergency Medicine 9133158710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
97.68 of 100Reported as group
Quality
92.69
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-3812IDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ies Arizona PLLC Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Ies Obs Arizona PLLC Emergency Medicine CurrentSince Jun 1, 2022 Accepting new patients
Ton Sells Hospital CurrentSince Aug 1, 2019 Accepting new patients
Saguaro Emergency Physicians Emergency Medicine Past Accepting new patients
Emcare Physician Providers, Inc Emergency Medicine Past Accepting new patients
Mountain Vista Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Idaho Emergency Physicians, P.a. Emergency Medicine PastSince Dec 1, 2011 Accepting new patients
Premier Emergency Physicians of Idaho Medical Group Emergency Medicine Past Accepting new patients
Treasure Valley Emergency Physicians Emergency Medicine Past Accepting new patients
Ton Sells Hospital Past Accepting new patients

Locations

5301 E Grant Rd
Tucson, AZ 85712
Phone (520) 324-1344

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790705283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 RIVER HEIGHTS DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425166",
            "telephone_number": "208-841-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866008",
            "telephone_number": "208-463-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTMAN",
        "first_name": "ROGER",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-3812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.