ST MICHAEL NEPHROLOGY, PLLC (NPI# 1144887050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144887050 |
| Entity Type | Organization |
| Organization Name | ST MICHAEL NEPHROLOGY, PLLC |
| Other Organization Name | ST MIKES NEPH |
| Practice Address |
1674 S Loggers Pond Pl Apt 14 Boise ID 83706-7517 |
| Mailing Address |
999 W Main St Ste 100 Boise ID 83702-9001 |
| Practice Telephone | 9862008202 |
| Practice Fax Number | 6265934751 |
| Enumeration Date | 2019-05-26 |
| Last Update Date | 2019-07-14 |
| Authorized Official Name | DR. ERNEST DANIEL MORENO DYTIAPCO (NEPHROLOGIST) |
| Authorized Official Telephone | 9862008202 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| St Mikes Neph | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 190 E Bannock St, Boise, ID 83712 | 9862008202 |
| Street Address |
1674 S LOGGERS POND PL APT 14 |
| City | BOISE |
| State | ID |
| Zip Code | 83706-7517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063719292 | St Clair Specialty Physicians | Internal Medicine | 5610 Gage Street, Suite A, Boise, ID 83706 | 2011-02-24 |
| 1497931893 | Mark David Poirier | Internal Medicine | 5610 W Gage St Ste A, Boise, ID 83706 | 2008-01-15 |
| 1780621771 | Nicholas C Hunt I | Internal Medicine | 5610 W Gage St, Suite A, Boise, ID 83706-1349 | 2006-05-31 |
| 1598789950 | Idaho Nephrology Associates, L.l.c | Internal Medicine | 5610 Gage St, Suite A, Boise, ID 83706-1349 | 2006-07-27 |
| 1164459541 | Jon Parker Wagnild | Internal Medicine | 5610 Gage St, Suite A, Boise, ID 83706-1349 | 2006-06-28 |
| 1952343352 | Thomas J Pintar | Internal Medicine | 5610 W Gage St, Suite A, Boise, ID 83706-1349 | 2006-06-11 |
| 1851345193 | Micheal John Adcox | Internal Medicine | 333 N 1st St, Suite 140, Boise, ID 83702-6100 | 2006-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932586294 | University of Utah Adult Services | Internal Medicine | 250 South Eagle Road, Meridian, ID 83642 | 2015-05-06 |
| 1033483052 | Magic Valley Kidney Institute LLP | Internal Medicine | 350 N Haven St Ste 200, Twin Falls, ID 83301-5788 | 2012-03-08 |
| 1558680587 | Brian Doxey Snow | Internal Medicine | 4424 E Flamingo Ave Ste 340, Nampa, ID 83687-9306 | 2010-06-01 |
| 1609952381 | Ajith J Kumar | Internal Medicine | 2124 12th Ave, Lewiston, ID 83501-3502 | 2006-10-27 |
| 1154406437 | Robert C Dobrowolski | Internal Medicine | 2131 S. Bonito Way, Meridian, ID 83642 | 2006-10-26 |
| 1235151077 | Vashu Deoomal Thakur | Internal Medicine | 166 S 5th St, Montpelier, ID 83254-1557 | 2006-07-24 |
| 1720074990 | Sherwin S. Foster | Internal Medicine | 8836 N Hess St, Suite C, Hayden, ID 83835-8718 | 2005-09-23 |
| 1578915898 | Rc Dobrowolski PC | Internal Medicine | 2131 S Bonito Way, Meridian, ID 83642-1659 | 2016-07-11 |
| 1013395268 | University of Utah Adult Services | Internal Medicine | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2015-05-08 |
| 1588041131 | University of Utah Adult Services | Internal Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2015-05-04 |
| Find all providers with the same taxonomy | ||||
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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.