NPIMap

Individual provider Active NPI

Kevin T Rich, M.D.

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1902833031
Registry record updated Apr 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M6781 Issued in ID
Practice address
777 N Raymond St
Boise, ID 83704-9251
Phone
(208) 514-2500
Fax
(208) 375-2217
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M6781 ID Primary

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 identifiers 1

IdentifierTypeStateIssuer
003899300MedicaidID

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
I20070926001146 ID Practitioner - Family Practice 0446345102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Un of California, Irvine, College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Full Circle Health IncGroup PAC ID 6709986797, 106 clinicians

Practice addresses (Care Compare)

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M6781IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Full Circle Health, Inc. CurrentSince Jun 14, 2007 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030

325 W Idaho St
Boise, ID 83702
Phone (208) 514-2525

6565 W Emerald St
Boise, ID 83704
Phone (208) 377-5055

215 W 35th St
Garden City, ID 83714
Phone (208) 384-5200

708 E Wythe Creek Ct
Ste 103
Kuna, ID 83634
Phone (208) 922-5130

2275 S Eagle Rd
Ste 120
Meridian, ID 83642
Phone (208) 514-2520

2321 E Gala St
Ste 2
Meridian, ID 83642
Phone (208) 288-2255

Interoperability endpoints

  • Direct secure messaging: krich295131@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Full Circle HealthBoise, ID, CCN 131835 Federally qualified health center Corporate Officer Jul 1, 1995
Full Circle HealthBoise, ID, CCN 131839 Federally qualified health center Corporate Officer Jul 1, 1995
Full Circle HealthMeridian, ID, CCN 131844 Federally qualified health center Corporate Officer Jul 1, 1995
Full Circle HealthBoise, ID, CCN 131843 Federally qualified health center Corporate Officer Jul 1, 2013
Full Circle HealthKuna, ID, CCN 131857 Federally qualified health center Corporate Officer Jul 1, 1995
Full Circle HealthNampa, ID, CCN 131879 Federally qualified health center Corporate Officer Jul 1, 2013
Full Circle HealthNampa, ID, CCN 131885 Federally qualified health center Corporate Officer Jul 1, 2013
Full Circle HealthCaldwell, ID, CCN 131033 Federally qualified health center Corporate Officer Jul 1, 2013
Full Circle Health IncCaldwell, ID, CCN 131055 Federally qualified health center Corporate Officer Jul 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 8

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555027200000",
    "number": "1902833031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICH",
        "first_name": "KEVIN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2019-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M6781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003899300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.