NPIMap

Organization Active NPI

Capital Surgical Associates, PA

  • Surgery Physician
  • Boise, ID
National Provider Identifier
1902854433
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CAPITAL SURGICAL ASSOCIATES, PA
Practice address
8854 W Emerald St
Suite 140
Boise, ID 83704-4845
Phone
(208) 321-4790
Fax
(208) 321-4836
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

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

Authorized official

Name
Lisa Jack
Title
Practice Manager
Phone
(208) 321-4790

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X

Addresses

Primary practice location

8854 W Emerald St
Suite 140
Boise, ID 83704-4845

Mailing address

8854 W Emerald St Ste 140
Boise, ID 83704-4845
Phone (208) 321-4790

Other identifiers 5

IdentifierTypeStateIssuer
290408OtherIDREGENCE BLUE SHIELD
807082700MedicaidID
89466OtherIDBLUE CROSS
13D2290127OtherIDCLIA
DC4854OtherIDTRAVELERS MEDICARE

Other names 1

  • Orthopaedic Associates, PA Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050120000630 ID Part B Supplier - Clinic/Group Practice 9133178767 Receives reassigned benefits from 10 practitioners
Practice locations: Boise, ID
O20260112000317 ID DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - General SurgeryDME Supplier - Physician - Urology 9133178767 Practice locations: Boise, ID

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
13D2290127Capital Surgical Associates PA8854 W Emerald St Ste 140, Boise, ID 83704Certificate of waiverSep 20, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756339200000",
    "number": "1902854433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 140",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044845",
            "telephone_number": "208-321-4790",
            "fax_number": "208-321-4836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST",
            "address_2": "SUITE 140",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044845",
            "telephone_number": "208-321-4790",
            "fax_number": "208-321-4836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL SURGICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A",
        "authorized_official_last_name": "JACK",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-321-4790"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "290408",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807082700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "89466",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "13D2290127",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE",
            "identifier": "DC4854",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopaedic Associates, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; 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.