NPIMap

Individual provider Active NPI

Juliann C Visser, PA-C

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1922309848
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA874 Issued in ID
Practice address
6454 W. Emerald Street
Boise, ID 83704-8734
Phone
(208) 377-0820
Fax
(208) 375-8046
NPI assigned
Nov 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA874 ID Primary

Addresses

Primary practice location

6454 W. Emerald Street
Boise, ID 83704-8734

Mailing address

6454 W. Emerald Street
Boise, ID 83704-8734
Phone (208) 377-0820

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address julie1@adawest.emadirect.md Direct

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
I20110104000453 ID Practitioner - Physician Assistant 3577752773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Group practices
Ada Dermatology P aGroup PAC ID 5395833586, 5 clinicians

Practice addresses (Care Compare)

6454 W Emerald St
Boise, ID 83704-8734
Phone (208) 377-0820

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA874IDMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: julie1@adawest.emadirect.md

Organizations & group practices 1

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

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": "1289260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1922309848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6454 W. EMERALD STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048734",
            "telephone_number": "208-377-0820",
            "fax_number": "208-375-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6454 W. EMERALD STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048734",
            "telephone_number": "208-377-0820",
            "fax_number": "208-375-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISSER",
        "first_name": "JULIANN",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-09",
        "last_updated": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "julie1@adawest.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1618 S Millenium Way Ste 100",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836426457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.