Katie R Allan, MD
Individual provider Active NPI Family Medicine Physician · Boise, ID
NPI 1871348367 · NPPES record last updated Apr 18, 2024
Key facts
- NPI
- 1871348367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MRM-2369 (ID)
- Practice address
- 777 N Raymond St
Boise, ID 83704-9251 - Phone
- (208) 514-2500
- NPI assigned
- Apr 18, 2024
- Sex
- Female
- Sole proprietor
- No
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240617002895 | ID | Order and Referring Only - Family Practice |
5496298655 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MRM-2369 | ID | MD | Family Medicine Physician |
Interoperability endpoints
- kallan697812@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MRM-2369 | ID | Yes |
Addresses
Primary practice location
777 N Raymond St
Boise, ID 83704-9251
Mailing address
777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500
Other providers in Boise, ID
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- All Together Now, Inc.
- All Together Now, LLC
- Benjamen Charles Allan
- Allante Family Medicine
- Allante Plastic Surgery
- Allegiance Behavioral Health LLC
- Allegiance Home Health Care LLC
- Tom Tore Allegrezza
All providers in Boise, ID · Family Medicine Physician 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 18, 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.