NPIMap

Individual provider Active NPI

Guillermo M Guzman Trevino, MD

  • Obstetrics & Gynecology Physician
  • Nampa, ID
National Provider Identifier
1881828010
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
M-12168 Issued in ID
Practice address
4424 E Flamingo
Suite 200
Nampa, ID 83687-9300
Phone
(208) 288-4888
Fax
(208) 288-4890
NPI assigned
May 1, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD29170 OR
Obstetrics & Gynecology Physician 207V00000X M-12168 ID Primary
Obstetrics & Gynecology Physician 207V00000X MD-29170 OR

Addresses

Primary practice location

4424 E Flamingo
Suite 200
Nampa, ID 83687-9300

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170

Other identifiers 2

IdentifierTypeStateIssuer
500609069MedicaidOR
808416200OtherIDIDAHO MEDICAID

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
I20140121001636 ID Practitioner - Obstetrics/Gynecology 0345386330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

1072 N Liberty St
Boise, ID 83704-8708

3025 W Cherry LN
Meridian, ID 83642-8531

4424 E Flamingo Ave
Nampa, ID 83687-9300

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD-29170ORMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc Obstetrics & Gynecology CurrentSince Dec 9, 2013 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 9, 2013 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Past Accepting new patients
Saint Alphonsus Specialty Services Inc Obstetrics & Gynecology Past Accepting new patients

Locations

1072 N Liberty St
Ste 100
Boise, ID 83704
Phone (208) 302-1200

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

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

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

4424 E Flamingo Ave
Ste 200
Nampa, ID 83687
Phone (208) 302-1400

1050 SW 3rd Ave
Ste 3200
Ontario, OR 97914
Phone (541) 881-7035

351 SW 9th St
Ontario, OR 97914
Phone (541) 881-7000

1050 SW 3rd Ave
Ste 1600
Ontario, OR 97914
Phone (541) 881-2360

1050 SW 3rd Ave
Ste 1200
Ontario, OR 97914
Phone (541) 881-7451

Interoperability endpoints

  • Direct secure messaging: tguzman84965@direct.trinity-health.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1881828010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 E FLAMINGO",
            "address_2": "SUITE 200",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836879300",
            "telephone_number": "208-288-4888",
            "fax_number": "208-288-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUZMAN TREVINO",
        "first_name": "GUILLERMO",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-01",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "MD29170",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "M-12168",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "MD-29170",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500609069",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO MEDICAID",
            "identifier": "808416200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.