NPIMap

Individual provider Active NPI

Robert E Shumaker, PA

  • Medical Physician Assistant
  • Boise, ID
National Provider Identifier
1902867849
Registry record updated May 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-1361 Issued in ID
Practice address
1075 N Curtis Road
Ste 300
Boise, ID 83706
Phone
(208) 367-3330
Fax
(208) 367-3331
NPI assigned
Mar 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-1361 ID Primary
Medical Physician Assistant 363AM0700X MA052341 PA

Addresses

Primary practice location

1075 N Curtis Road
Ste 300
Boise, ID 83706

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-3330

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
I20160419000710 ID Practitioner - Physician Assistant 1355366840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vibra Physicians LLCGroup PAC ID 8921233933, 30 clinicians

Practice addresses (Care Compare)

2131 S Bonito Way
Meridian, ID 83642-1659
Phone (208) 489-9500

6651 W Franklin Rd
Boise, ID 83709-0914
Phone (208) 825-3007

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013
  • Vibra Hospital of Boise Long-term care hospital, Boise, ID, CCN 132002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA052341PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Aug 6, 2024 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
Spirit Physician Services Inc. Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

720 E Park Blvd
Ste 200
Boise, ID 83712
Phone (208) 381-3939

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

1202 E Locust St
Emmett, ID 83617
Phone (208) 365-2338

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

Organizations & group practices 4

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 7

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": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462924800000",
    "number": "1902867849",
    "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": "208-367-3330",
            "fax_number": "208-367-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N CURTIS ROAD",
            "address_2": "STE 300",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83706",
            "telephone_number": "208-367-3330",
            "fax_number": "208-367-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMAKER",
        "first_name": "ROBERT",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2016-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1361",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA052341",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.