Joseba Bidaburu
Individual provider Active NPI Physician Assistant · Meridian, ID
NPI 1821727140 · NPPES record last updated Apr 25, 2024
Key facts
- NPI
- 1821727140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA-2742 (ID)
- Practice address
- 3280 E Lanark Dr
Meridian, ID 83642-5982 - Phone
- (208) 895-8670
- Fax
- (208) 955-0494
- NPI assigned
- Jun 10, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 20
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Alliance Medical Group LLC
Practice addresses (Care Compare)
10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500
1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860
6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240506003199 | ID | Practitioner - Physician Assistant | 9739529843 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-2742 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Medical Group, LLC | Current |
Accepting new patients | |
| Alliance Medical Group, LLC | Current |
Accepting new patients | |
| Alliance Medical Group, LLC | Past | Accepting new patients |
Locations
10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690
3280 E Lanark Dr
Meridian, ID 83642
Phone (208) 377-4400
Interoperability endpoints
- joseba.bidaburu@phmg.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA-2742 | ID | Yes |
Addresses
Primary practice location
3280 E Lanark Dr
Meridian, ID 83642-5982
Mailing address
PO Box 191050
Boise, ID 83719-1050
Phone (208) 985-1423
Other practice location 1
536 S Hemingway Ave
Boise, ID 83709-7752
Phone (208) 591-0123
Other providers in Meridian, ID
- Joshua Beveridge
- BHG Lxxxvii, LLC
- Kelli Gene Bia
- Albert Donald Bickford
- Danielle Bickford
- Charles David Bierle
- Bradley Alexander Bigford
- Morgan Biggs
- Angela Christine Billingsley
- Montrice Billingsley
All providers in Meridian, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.