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Organization Active NPI

St Lukes Regional Medical Center

Doing business as St Lukes Developmental Pediatrics

  • Developmental - Behavioral Pediatrics Physician
  • Boise, ID
National Provider Identifier
1972627628
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
03 Issued in ID
Legal business name
ST LUKES REGIONAL MEDICAL CENTER
Doing business as
St Lukes Developmental Pediatrics
Practice address
100 E Idaho St
Ste 200
Boise, ID 83712-6223
Phone
(208) 381-7312
NPI assigned
Mar 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jerry Hirschfeld
Title
Administrator
Phone
(208) 381-2818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0006X 03 ID Primary

Addresses

Primary practice location

100 E Idaho St
Ste 200
Boise, ID 83712-6223

Mailing address

PO Box 550
Boise, ID 83701-0550
Phone (208) 381-7312

Other identifiers 1

IdentifierTypeStateIssuer
03OtherIDHOSPITAL STATE LIC #

Other names 1

  • ST LUKES DEVELOPMENTAL PEDIATRICS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Richard H Lane MD50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972627628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837010550",
            "telephone_number": "208-381-7312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "address_2": "STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126223",
            "telephone_number": "208-381-7312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HIRSCHFELD",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-381-2818"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "ID",
            "license": "03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL STATE LIC #",
            "identifier": "03",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKES DEVELOPMENTAL PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.