IDAHO SPORTS MEDICINE INSTITUTE PA – NPI #1154356624
Neuromusculoskeletal Medicine, Sports Medicine
A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
IDAHO SPORTS MEDICINE INSTITUTE PA is a provider located in BOISE, ID. NPPES has assigned the NPI number 1154356624 to IDAHO SPORTS MEDICINE INSTITUTE PA on July 12, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 204C00000X from the Health Care Provider Taxonomy code set, which is classified as Neuromusculoskeletal Medicine, Sports Medicine.
The NPI profile was last updated on Jan 06, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for IDAHO SPORTS MEDICINE INSTITUTE PA below.
NPI Profile for
IDAHO SPORTS MEDICINE INSTITUTE PA
(about 20 years ago)
BOISE, ID 83706-3009 Phone: (208) 336-8250 Fax: (208) 345-9514
BOISE, ID 83706-3009 Phone: (208) 336-8250 Fax: (208) 345-9514
OWNER/PARTNER
Phone: (208) 336-8250
Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.
Identifiers for IDAHO SPORTS MEDICINE INSTITUTE PA
Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.
| Description | Issuer | State | Identifier |
|---|---|---|---|
| other | BLUE CROSS OF IDAHO GROUP | ID | 8628-0 |
| other | GROUP # 29145 | ID | REGENCE BLUE SHIELD |
| medicaid | ID | 805993900 |
A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.
| Taxonomy Classification / Specialization | State | License |
|---|---|---|
| 204C00000X - Neuromusculoskeletal Medicine, Sports Medicine (Primary) |
N/A FOR GROUP |
The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.