Landon Mitchel Favero

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2428 Issued in ID

Practice address

701 E Parkcenter Blvd
Boise, ID 83706-6528

Phone

(208) 381-6500

NPI assigned

Oct 31, 2018

Last updated

Aug 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, ID2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2018

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)

Hospital & facility affiliations

• St Luke's Regional Medical Center Hospital, Boise, ID, CCN 130006

Merit-based Incentive Payment System (MIPS)

Final score

87.3 of 100Reported as group

Quality

81.29

Promoting interoperability

100

Improvement activities

40

Cost

76.37

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  Medicare reassignment Care Compare group NPD
• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199
  Medicare reassignment NPD
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1205300407
  Medicare reassignment
• Urgent Care Associates PLLC

  • Preferred Provider Organization
  • Idaho Falls, ID
  • NPI 1609046408
  NPD
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Butte, MT
  • NPI 1871220038
  NPD
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Lukes Regional Medical Center

  dba Air St Luke's

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1801363577",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066528",
            "telephone_number": "208-381-6500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 N 500 W",
            "address_purpose": "LOCATION",
            "city": "Vernal",
            "state": "UT",
            "postal_code": "840781907",
            "country_code": "US",
            "telephone_number": "801-915-7265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAVERO",
        "first_name": "LANDON",
        "middle_name": "MITCHEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-31",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2428",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "11240954-1206",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Rose Fassi, LGC
• Elizabeth Irene Fassig, PSY.D.
• Nathan Fauntleroy, LMSW
• William Ernest Faure, OD
• Sarah Maria Fauth, LMSW
• Roycie Faye
• Rebekah G Fayette, CNM, PMHNP
• Sarah Shanti Fazel
• Katherine Fazio, LCSW
• Fazzio Clinic PC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.