DR. BARRY JUSTIN CUSACK


Address: 500 West Fort St, (111), Boise, ID 83702-4598
Phone: 2084221000

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RG0300X Internal Medicine
Specialization: Geriatric Medicine
M5678 ID Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
ID STATE MEDICAL LICENCE M5678 01

Office Location

Street Address 500 WEST FORT ST
(111)
City BOISE
State ID
Zip Code 83702-4598

Providers in the same location

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

Providers in the same zip code

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1790321966 Inland Northwest Neuromonitoring Pllc Psychiatry & Neurology 950 Bannock Street, Suite 1100, Boise, ID 83702 2019-11-22
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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 Information

Taxonomy Code 207RG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Geriatric Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1962468025 Charles E Boult Internal Medicine 5966 W Curtisian Ave, Boise, ID 83706 2006-04-26

Providers in the same taxonomy and state

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

Competitor

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City BOISE
Zip Code 83702

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Dataset Information

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.

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