Individual provider Active NPI

Rebecca Leigh Gomez, APRN

  • Family Nurse Practitioner
  • Boise, ID
National Provider Identifier
1932886017
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
64259 Issued in ID
Practice address
3046 S Bown Way Ste a
Boise, ID 83706-5499
Phone
(208) 515-0843
NPI assigned
Jun 30, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 64259 ID Primary

Addresses

Primary practice location

3046 S Bown Way Ste a
Boise, ID 83706-5499

Mailing address

3046 S Bown Way Ste a
Boise, ID 83706-5499
Phone (208) 515-0843

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250307002825 ID Practitioner - Nurse Practitioner 1153842067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mangum Primary Care LLCGroup PAC ID 0547706509, 2 clinicians

Practice addresses (Care Compare)

3046 S Bown Way
Boise, ID 83706-5499
Phone (208) 580-8888

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mangum Primary Care LLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

3046 S Bown Way
Boise, ID 83706
Phone (208) 580-8888

3046 S Bown Way
Ste A
Boise, ID 83706
Phone (208) 318-6561

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1932886017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3046 S BOWN WAY STE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065499",
            "telephone_number": "208-515-0843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3046 S BOWN WAY STE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065499",
            "telephone_number": "208-515-0843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "REBECCA",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "64259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.