Individual provider Active NPI

Kathleen M Scanlan, MD

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1972545465
Registry record updated Dec 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M7309 Issued in ID
Practice address
12273 W McMillan Rd
Boise, ID 83713-0555
Phone
(208) 367-6330
Fax
(208) 367-4765
NPI assigned
Jun 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M7309 ID Primary

Addresses

Primary practice location

12273 W McMillan Rd
Boise, ID 83713-0555

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5189

Other identifiers 1

IdentifierTypeStateIssuer
003922300MedicaidID

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041014000902 ID Practitioner - Family Practice 9739148222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2141 E Parkcenter Blvd
Boise, ID 83706-6701
Phone (208) 302-5000

3025 W Cherry LN
Meridian, ID 83642-8531

6533 W Emerald St
Boise, ID 83704-8737
Phone (208) 302-5200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M7309IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc Family Medicine CurrentSince May 1, 2016 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince May 1, 2016 Accepting new patients

Locations

12273 W McMillan Rd
Boise, ID 83713
Phone (208) 302-5500

315 E Elm St
Ste 100
Caldwell, ID 83605
Phone (208) 302-7100

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

520 S Eagle Rd
Ste 1241
Meridian, ID 83642
Phone (208) 288-2255

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

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

Interoperability endpoints

  • Direct secure messaging: kscanlan1564139@direct.trinity-health.org

Organizations & group practices 3

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": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230681600000",
    "number": "1972545465",
    "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": "208-367-5189",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12273 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130555",
            "telephone_number": "208-367-6330",
            "fax_number": "208-367-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLAN",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2008-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003922300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.