NPIMap

Organization Active NPI

Digestive Health Clinic LLC

Doing business as Nampa Digestive Health Clinic

  • Gastroenterology Physician
  • Nampa, ID
National Provider Identifier
1891310561
Registry record updated Jun 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIGESTIVE HEALTH CLINIC LLC
Doing business as
Nampa Digestive Health Clinic
Practice address
5080 E Commerce St
Nampa, ID 83687-5513
Phone
(986) 867-1600
Fax
(986) 867-1601
NPI assigned
Jun 9, 2020
Last updated
Jun 19, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DIGESTIVE HEALTH CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2020

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

Authorized official

Name
Mark A Mallory, MDNPI 1336116888
Title
Manager
Phone
(208) 489-1900

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

5080 E Commerce St
Nampa, ID 83687-5513

Mailing address

6259 W Emerald St
Boise, ID 83704-8731
Phone (208) 489-1900

Other names 1

  • Nampa Digestive Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070125000398 ID Part B Supplier - Clinic/Group Practice 7315948874 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID; Meridian, ID; Nampa, ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2195915Nampa Digestive Health Clinic5080 E Commerce St, Nampa, ID 83687Certificate of waiverOct 12, 2026

National Provider Directory

National Provider Directory
Part of
Digestive Health Clinic LLC

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592524800000",
    "number": "1891310561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6259 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048731",
            "telephone_number": "208-489-1900",
            "fax_number": "208-489-1929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5080 E COMMERCE ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875513",
            "telephone_number": "986-867-1600",
            "fax_number": "986-867-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE HEALTH CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIGESTIVE HEALTH CLINIC LLC",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A",
        "authorized_official_last_name": "MALLORY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-489-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nampa Digestive Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.