Individual provider Active NPI

Michael Bryan Loegering, NP

  • Nurse Practitioner
  • Boise, ID
National Provider Identifier
1821038704
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP727A Issued in ID
Practice address
413 Allumbaugh St
Suite 101
Boise, ID 83704-9212
Phone
(208) 323-1125
Fax
(208) 323-9604
NPI assigned
Jun 7, 2006
Last updated
Apr 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP727A ID Primary

Addresses

Primary practice location

413 Allumbaugh St
Suite 101
Boise, ID 83704-9212

Mailing address

413 Allumbaugh St
Suite 101
Boise, ID 83704-9212
Phone (208) 323-1125

Other identifiers 1

IdentifierTypeStateIssuer
807460100MedicaidID

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061016000164 ID Practitioner - Nurse Practitioner 3476559477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Sage Healthcare PLLCGroup PAC ID 7810974904, 10 clinicians

Practice addresses (Care Compare)

413 N Allumbaugh St
Suite 101
Boise, ID 83704-9219
Phone (208) 323-1125

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP727AIDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sage Healthcare PLLC Family Medicine CurrentSince May 1, 2008 Accepting new patients

Locations

303 N Allumbaugh St
Boise, ID 83704
Phone (208) 376-1611

413 N Allumbaugh St
Ste 101
Boise, ID 83704
Phone (208) 323-1125

Organizations & group practices 1

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 5

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1821038704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 ALLUMBAUGH ST",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049212",
            "telephone_number": "208-323-1125",
            "fax_number": "208-323-9604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 ALLUMBAUGH ST",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049212",
            "telephone_number": "208-323-1125",
            "fax_number": "208-323-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOEGERING",
        "first_name": "MICHAEL",
        "middle_name": "BRYAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP727A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807460100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.