MERCY PHYSICIAN GROUP INC. (NPI# 1104972983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104972983 |
| Entity Type | Organization |
| Organization Name | MERCY PHYSICIAN GROUP INC. |
| Practice Address |
1512 12th Ave Rd Nampa ID 83686-6008 |
| Practice Telephone | 2084635000 |
| Practice Fax Number | 2084635578 |
| Mailing Telephone | 2084635000 |
| Mailing Fax Number | 2084635578 |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2008-04-14 |
| Authorized Official Name | MR. B LANNIE CHECKETTS (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2084635531 |
| Authorized Official Credential | CFO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207QA0000X |
Family Medicine Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
1512 12TH AVE RD |
| City | NAMPA |
| State | ID |
| Zip Code | 83686-6008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013905355 | Steve Edward Roberts | Anesthesiology | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2005-10-11 |
| 1295141992 | Jane Stroebel | Pharmacist | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2014-07-02 |
| 1881973899 | Olawale Olaniyi | Internal Medicine | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2011-08-08 |
| 1730407461 | Sound Physicians of Idaho | Family Medicine | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2010-05-05 |
| 1821229279 | Patrick Daniel Vargas Villazon | Internal Medicine | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2009-08-03 |
| 1275772758 | James M Ineck | Pharmacist | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2009-02-06 |
| 1336388974 | Jesse Vanwart | Pharmacist | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2009-02-04 |
| 1942461850 | Joseph M. Mortensen | Anesthesiology | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2008-06-23 |
| 1235260845 | Donald G Rau | Radiology | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2007-03-07 |
| 1083751366 | Jeffrey Wayne Grossman | Radiology | 1512 12th Ave Rd, Nampa, ID 83686-6008 | 2007-01-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184255960 | Kristine Lynn Fitts-eisenbrandt | Social Worker | 270 W. Gerogia Ave., Nampa, ID 83686 | 2020-01-30 |
| 1669025706 | Vitality Family Chiropractic, Pllc | Chiropractor | 3189 E Greenhurst Rd, Nampa, ID 83686 | 2019-07-18 |
| 1871150185 | King's Peak Investments, Inc. | Substance Abuse Rehabilitation Facility | 8898 Idaho 45, Nampa, ID 83686 | 2019-05-22 |
| 1154805786 | Jmj Nampa LLC | Dentist | 914 12th Ave Rd, Nampa, ID 83686 | 2018-09-19 |
| 1518448703 | Michel Cox | Pharmacy Technician | 2219 12th Ave S, Nampa, ID 83686 | 2018-08-24 |
| 1437504909 | 5 Peppers Inc | Family Medicine | 217 W. Georgia Ave. Ste 120, Nampa, ID 83686 | 2016-05-03 |
| 1811369549 | Anna Stoia | Physician Assistant | 4401 E. Tuscany Ave., Nampa, ID 83686 | 2015-10-21 |
| 1144699307 | Jamie Green | Social Worker | 112 12th Avenue Rd., Nampa, ID 83686 | 2015-09-17 |
| 1174927933 | Bower Chiropractic Inc | Chiropractor | 304 12th Ave Rd, Nampa, ID 83686 | 2014-10-22 |
| 1285037093 | Rosemary Phelps | Registered Nurse | 353 W. Iowa, Nampa, ID 83686 | 2014-10-07 |
| Find all providers in zip 83686 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003866765 | Christina R Bjornstad | Family Medicine | 625 6th Ave, Lewiston, ID 83501-9999 | 2006-05-11 |
| 1326435850 | Cynthis Sandlin | Family Medicine | 9382 W Overland Rd, Boise, ID 83709-2505 | 2015-04-22 |
| 1679745590 | William Thomas Edwards | Family Medicine | 1055 N Curtis Road, Boise, ID 83706 | 2008-04-01 |
| 1659405140 | Gene K. Hodges M.d. | Family Medicine | 2065 E 17th St, Suite A, Idaho Falls, ID 83404-8042 | 2007-03-15 |
| 1366503955 | John Edward Riley | Family Medicine | 300 Hospital Dr, Orofino, ID 83544-9034 | 2006-12-13 |
| 1528156577 | Ronald K Arbon | Family Medicine | 2860 Channing Way, Suite 116, Idaho Falls, ID 83404-7531 | 2006-10-11 |
| 1699723411 | David James Luther | Family Medicine | 229 S. 7th Street, Saint Maries, ID 83861 | 2006-05-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.