The Shoulder Clinic of Idaho PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

THE SHOULDER CLINIC OF IDAHO PLLC

Practice address

8854 W Emerald St
Ste 102
Boise, ID 83704-4844

Phone

(208) 323-4747

Fax

(208) 323-4848

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Earl Goodwin, M.D.

Title

Owner

Phone

(208) 323-4747

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Michael Chopp, MD

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1720081060
  Medicare reassignment Care Compare group NPD
• Jared S Johnson, MD

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1891982559
  Medicare reassignment Care Compare group NPD
• Joseph Randall Lynch, MD

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1205944303
  Medicare reassignment Care Compare group NPD
• Jeffrey J. Griggs, PA

  • Surgical Physician Assistant
  • Boise, ID
  • NPI 1861575797
  Medicare reassignment Care Compare group
• Michael Robert Nieraeth, PA

  • Surgical Physician Assistant
  • Boise, ID
  • NPI 1487904280
  Medicare reassignment Care Compare group
• Kiira Vazales Speigl, PA

  • Orthopaedic Surgery Physician
  • Petoskey, MI
  • NPI 1164063368

  ID

  Medicare reassignment

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1821164138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S BONITO WAY STE 190",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425618",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST",
            "address_2": "STE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044844",
            "telephone_number": "208-323-4747",
            "fax_number": "208-323-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SHOULDER CLINIC OF IDAHO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-323-4747",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Pediatric and Adolescent Center, Inc.
• The Pharmacy Doctor, Inc.
• The PT Next Door
• The Red Fox Group
• The Regents of the University of Idaho
• The Spaulding Home LLC
• The Undiscovered Self, PC
• The Village Charter School, Inc.
• The Young Mens Christian Association of Boise City Idaho
• Kristine Lynn Theis, NP

• Orthopaedic Surgery Physician in Boise, ID
• Providers in Boise, ID by specialty
• Orthopaedic Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.