NPIMap

Organization Active NPI

Humphreys Diabetes Center

  • Registered Dietitian
  • Boise, ID
National Provider Identifier
1821263088
Registry record updated Nov 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
D33630 Issued in ID
Legal business name
HUMPHREYS DIABETES CENTER
Practice address
1226 W River St
Boise, ID 83702-7049
Phone
(208) 331-1155
Fax
(208) 383-0190
NPI assigned
Apr 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2008

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

Authorized official

Name
Mr. Robert W Scanlon
Title
Executive Director
Phone
(208) 331-1155

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X PSY331 ID
Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133V00000X D33630 ID Primary

Addresses

Primary practice location

1226 W River St
Boise, ID 83702-7049

Mailing address

1226 W River St
Boise, ID 83702-7049
Phone (208) 331-1155

Other identifiers 3

IdentifierTypeStateIssuer
8G502OtherIDBLUE CROSS
806348400MedicaidID
1374744OtherIDMEDICARE MNT

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1821263088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-331-1155",
            "fax_number": "208-383-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-331-1155",
            "fax_number": "208-383-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMPHREYS DIABETES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-11-21",
        "status": "A",
        "authorized_official_last_name": "SCANLON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-331-1155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY331",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D33630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8G502",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806348400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MNT",
            "identifier": "1374744",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.