Individual provider Active NPI

Daniel T Whitted, PA-C

  • Medical Physician Assistant
  • Boise, ID
National Provider Identifier
1942590914
Registry record updated Apr 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-884 Issued in ID
Practice address
6590 W Norwood Dr
Boise, ID 83704-8765
Phone
(208) 855-2410
Fax
(208) 855-0157
NPI assigned
Apr 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2011

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-884 ID Primary
Surgical Physician Assistant 363AS0400X PA-884 ID

Addresses

Primary practice location

6590 W Norwood Dr
Boise, ID 83704-8765

Mailing address

6590 W Norwood Dr
Boise, ID 83704-8765
Phone (208) 855-2410

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
I20110519000284 ID Practitioner - Physician Assistant 4385820752 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Direct Orthopedic Care LLCGroup PAC ID 2163648155, 32 clinicians

Practice addresses (Care Compare)

4842 N Cortona Way
Suite 110
Meridian, ID 83646-3171
Phone (208) 321-4000

7979 W Rifleman St
Suite 110
Boise, ID 83704-9066
Phone (208) 321-4000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-884IDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Direct Orthopedic Care LLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

7979 W Rifleman St
Ste 110
Boise, ID 83704
Phone (208) 321-4000

3015 E Magic View Dr
Ste 130
Meridian, ID 83642
Phone (208) 482-5567

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.

NPI Registry JSON

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302566400000",
    "number": "1942590914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6590 W NORWOOD DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048765",
            "telephone_number": "208-855-2410",
            "fax_number": "208-855-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6590 W NORWOOD DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048765",
            "telephone_number": "208-855-2410",
            "fax_number": "208-855-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTED",
        "first_name": "DANIEL",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-12",
        "last_updated": "2011-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-884",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-884",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.