DR. BARRY JUSTIN CUSACK (NPI# 1720187289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1720187289 |
Entity Type | Individual |
Full Name | DR. BARRY JUSTIN CUSACK |
Credential | MD |
Practice Address |
500 West Fort St (111) Boise ID 83702-4598 |
Mailing Address |
9550 Chelan Ave Garden City ID 83714-1264 |
Practice Telephone | 2084221000 |
Practice Fax Number | 2084221319 |
Mailing Telephone | 2083758560 |
Enumeration Date | 2006-09-21 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
M5678 | ID | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | STATE MEDICAL LICENCE | M5678 | 01 |
Street Address |
500 WEST FORT ST (111) |
City | BOISE |
State | ID |
Zip Code | 83702-4598 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023110244 | Daniel Joseph Mac Donald | Social Worker | 500 West Fort St, Boise Vamc, Boise, ID 83702 | 2006-09-01 |
1093178154 | Michael Pestotnik | Internal Medicine | 500 West Fort St, #111r, Boise, ID 83702 | 2016-04-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
Find all providers in zip 83702 |
Taxonomy Code | 207RG0300X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Geriatric Medicine |
An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
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 |
---|---|---|---|---|
1962468025 | Charles E Boult | Internal Medicine | 5966 W Curtisian Ave, Boise, ID 83706 | 2006-04-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265621908 | On Site for Seniors Inc | Internal Medicine | 296 W Sunset Ave Ste 14, Coeur D Alene, ID 83815-8367 | 2007-10-18 |
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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.