NPIMap

Individual provider Active NPI

Mark Thomas Pyburn, NP

  • Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1871206789
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
74921 Issued in ID
Practice address
867 S Vanguard Way
Meridian, ID 83642-7552
Phone
(208) 302-7950
Fax
(208) 302-7955
NPI assigned
Jan 5, 2023
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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 74921 ID Primary

Addresses

Primary practice location

867 S Vanguard Way
Meridian, ID 83642-7552

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

8971 W Overland Rd
Boise, ID 83709-1651
Phone (208) 378-4288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230308002434 ID Practitioner - Nurse Practitioner 4385017524 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10717 W State St
Star, ID 83669-6046
Phone (208) 302-6300

1510 12TH Ave Rd
Suite 200
Nampa, ID 83686-6008
Phone (208) 302-6899

1512 12TH Ave Rd
Suite 100
Nampa, ID 83686-6008
Phone (208) 467-1171

3025 W Cherry LN
Meridian, ID 83642-8531

867 S Vanguard Way
Meridian, ID 83642-7552
Phone (208) 302-7950

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.87 of 100Reported as group
Quality
77.29
Promoting interoperability
97
Improvement activities
40
Cost
74.78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74921IDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Nov 15, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Nurse Practitioner Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Nov 15, 2024 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Nov 15, 2024 Accepting new patients
Southern Idaho Health Partners LLC CurrentSince Sep 23, 2024 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Nov 15, 2024 Accepting new patients

Locations

910 NW 16th St
Ste 101
Fruitland, ID 83619
Phone (208) 452-8000

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

867 S Vanguard Way
Meridian, ID 83642
Phone (208) 302-7950

Interoperability endpoints

  • Direct secure messaging: mpyburn3757241@direct.trinity-health.org

Organizations & group practices 6

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": "1672876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1871206789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 S VANGUARD WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427552",
            "telephone_number": "208-302-7950",
            "fax_number": "208-302-7955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8971 W Overland Rd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837091651",
            "country_code": "US",
            "telephone_number": "208-378-4288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PYBURN",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-05",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "74921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.