Aaron Ackerson, ACNPC-AG
Individual provider Active NPI Acute Care Nurse Practitioner · Boise, ID
NPI 1982329751 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1982329751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- 9571036 (ID)
- Practice address
- 190 E Bannock St
Boise, ID 83712-6241 - Phone
- (208) 381-5500
- Fax
- (208) 381-2555
- NPI assigned
- Oct 5, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221206001645 | IL | Practitioner - Nurse Practitioner | 5698144152 | Reassigns benefits to 2 organizations |
| I20250228001070 | ID | Practitioner - Nurse Practitioner | 5698144152 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9571036 | ID | MD | Acute Care Nurse Practitioner |
| 209025003 | IL | MD | Acute Care Nurse Practitioner |
| 202209977NP-PP | OR | MD | Acute Care Nurse Practitioner |
| AP61290133 | WA | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Methodist Medical Center of Illinois | Acute Care | Current |
Accepting new patients |
| Methodist Medical Center of Illinois | Current | Accepting new patients | |
| Methodist Medical Center of Illinois | Current |
Accepting new patients | |
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| St Lukes Clinic-Treasure Valley LLC | Current |
Accepting new patients | |
| St Lukes Regional Medical Center | Past | Accepting new patients |
Locations
190 E Bannock St
#10
Boise, ID 83712
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986
221 NE Glen Oak Ave
Ste 514W
Peoria, IL 61636
Phone (309) 672-5733
112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402
Interoperability endpoints
- aackersonaprn388393@carlehiedirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | AP61290133 | WA | |
| Acute Care Nurse Practitioner | 363LA2100X | 209025003 | IL | |
| Acute Care Nurse Practitioner | 363LA2100X | 202209977NP-PP | OR | |
| Acute Care Nurse Practitioner | 363LA2100X | 9571036 | ID | Yes |
Addresses
Primary practice location
190 E Bannock St
Boise, ID 83712-6241
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Other practice location 1
209 W Northland Ave
Peoria, IL 61614-4950
Phone (815) 876-6349
Other providers in Boise, ID
- Achieve, LLC
- Acjcs
- Daniel Bryan Ackerman
- Jerrod Ackerman
- Robert Ackerman
- Matthew Ryan Ackley
- Nicole Lynn Ackley
- Acme Markets Inc
- Acme Markets Inc
- Lena Acosta
All providers in Boise, ID · Acute Care Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.