Ada Dermatology, P.a.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

M-5274 Issued in ID

Legal business name

ADA DERMATOLOGY, P.A.

Practice address

6454 W Emerald Street
Boise, ID 83704-8734

Phone

(208) 377-0820

NPI assigned

Oct 19, 2006

Last updated

Jan 30, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Richard Dale Blickenstaff, M.D.NPI 1265514582

Title

President

Phone

(208) 377-0820

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas Blickenstaff, M.D., M.S.

  • Dermatology Physician
  • Boise, ID
  • NPI 1437544582

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Rachel King, PA

  • Physician Assistant
  • Boise, ID
  • NPI 1205826245
  Medicare reassignment Care Compare group
• Preston S Smith, PA-C

  • Physician Assistant
  • Nampa, ID
  • NPI 1992794929
  Medicare reassignment Care Compare group
• Juliann C Visser, PA-C

  • Physician Assistant
  • Boise, ID
  • NPI 1922309848
  Medicare reassignment Care Compare group
• Holly Hawkins Wolf, PA-C

  • Physician Assistant
  • Boise, ID
  • NPI 1124370333
  Medicare reassignment Care Compare group
• Richard Dale Blickenstaff, M.D.

  • Procedural Dermatology Physician
  • Boise, ID
  • NPI 1265514582
  Authorized official Same address or phone

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1952483299",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADA DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "BLICKENSTAFF",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-377-0820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "ID",
            "license": "M-5274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002639100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Acute Rescue and Transport, Inc
• Ada Boi Inc (Ada-Boi Critical Care Transport Service)
• Ada County Eyecare, P.C.
• Ada County Juvenile Court Services
• Ada County Treatment Services
• Ada Home Health LLC
• Ada Orthopaedic Clinic
• Ada Pediatrics, P.a.
• Ada Plastic and Reconstructive Surgery
• Ada Surgical Associates, PA

• Procedural Dermatology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Procedural Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.