NPIMap

Organization Active NPI

Lifestages OB-GYN PLLC

  • Obstetrics & Gynecology Physician
  • Nampa, ID
National Provider Identifier
1871618892
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
M8105 Issued in ID
Legal business name
LIFESTAGES OB-GYN PLLC
Practice address
3908 E Flamingo Ave
Nampa, ID 83687-3102
Phone
(208) 442-8035
Fax
(208) 442-8038
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Authorized official

Name
Dustan Hughes, M.D.NPI 1770513228
Title
Owner
Phone
(208) 442-8038

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X M8105 ID Primary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X M8055 ID

Addresses

Primary practice location

3908 E Flamingo Ave
Nampa, ID 83687-3102

Mailing address

3908 E Flamingo Ave
Nampa, ID 83687-3102
Phone (208) 442-8035

Other identifiers 3

IdentifierTypeStateIssuer
807138400MedicaidID
806339500MedicaidID
806575300MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050525000635 ID Part B Supplier - Clinic/Group Practice 0648226266 Receives reassigned benefits from 9 practitioners
Practice locations: Nampa, ID

National Provider Directory

National Provider Directory

Locations

1611 12th Ave Rd
Ste B
Nampa, ID 83686
Phone (208) 442-8035

3908 E Flamingo Ave
Nampa, ID 83687
Phone (208) 442-8035

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1871618892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 E FLAMINGO AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836873102",
            "telephone_number": "208-442-8035",
            "fax_number": "208-442-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 E FLAMINGO AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836873102",
            "telephone_number": "208-442-8035",
            "fax_number": "208-442-8038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTAGES OB-GYN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "DUSTAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-442-8038",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "M8105",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "M8055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807138400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806339500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806575300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.