Active NPI 1609828003 Individual Practitioner Male Practitioner

Dr. Brian D Matteson , MD

Surgery - Vascular Surgery • Boise, ID

✓ Accepts Medicare Assignment

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Dr. Brian Matteson, MD is a registered Surgery - Vascular Surgery practitioner in Boise, ID. With approximately 32 years of clinical practice since graduating from University Of Minnesota Medical School in 1994, Dr. Matteson provides healthcare services at the registered practice location at 333 N 1ST ST.

Dr. Matteson is affiliated with St Lukes Clinic-Treasure Valley Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers, ultrasound study of arm or leg veins with compression and maneuvers, ultrasound study of arm and leg arteries. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

333 N 1st St
#280

Boise, ID 837026100

Telephone 2083456545

Fax 2083451213

Associated Practice Facility / Clinic

🏢 Women's Health Associates, Pllc Facility NPI 1013957885

Medicare Profile & Education

Medical School

University Of Minnesota Medical School

Graduation Year

1994

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery - Vascular Surgery in Boise, ID

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

32 Yrs +8.2 yrs vs City Avg

City Avg: 23.8 Yrs

State Avg: 26.0 Yrs

Regional Practice Density

15 Specialists

Practicing in Boise, ID (31 Statewide)

Telehealth Adoption Rate

6.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

60.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Matteson (32 Years) 32 Yrs

Boise Specialty Average (23.8 Years) 23.8 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	241	238	$50.00	$19.18
93970 Ultrasound study of arm or leg veins with compression and maneuvers	148	144	$80.39	$29.87
93922 Ultrasound study of arm and leg arteries	117	110	$28.00	$10.77
93880 Ultrasound of both sides of head and neck blood flow	93	92	$90.00	$34.48
93880 Ultrasound of both sides of head and neck blood flow	39	38	$90.00	$34.87
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	37	36	$50.00	$19.47
93922 Ultrasound study of arm and leg arteries	36	36	$28.00	$10.78
93926 Ultrasound of one leg arteries or artery grafts	30	30	$54.00	$21.12
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	28	28	$131.00	$50.65
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	27	27	$295.74	$122.70
76706 Ultrasound scan of abdominal aorta	24	24	$70.00	$24.13
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	23	22	$88.39	$34.43
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	20	18	$217.40	$89.66
76706 Ultrasound scan of abdominal aorta	17	17	$70.00	$24.14
93925 Ultrasound of leg arteries or artery grafts	17	17	$88.18	$34.53
99213 Established patient office or other outpatient visit, typically 15 minutes	16	16	$147.25	$60.94
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	16	16	$88.19	$34.46
93970 Ultrasound study of arm or leg veins with compression and maneuvers	15	15	$78.00	$30.26
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	15	15	$183.00	$75.20
93985 Complete ultrasound of artery and vein blood flow pre-op assessment on both sides of body for hemodialysis access	13	13	$87.85	$33.88
93979 Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan	13	13	$55.46	$21.61
93990 Ultrasound of dialysis access	11	11	$54.00	$20.87

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	213	206	$48.47	$19.97
93922 Ultrasound study of arm and leg arteries	124	119	$27.25	$11.08
93970 Ultrasound study of arm or leg veins with compression and maneuvers	116	115	$74.79	$31.18
93880 Ultrasound of both sides of head and neck blood flow	90	90	$87.20	$36.09
93880 Ultrasound of both sides of head and neck blood flow	41	41	$86.68	$36.10
93926 Ultrasound of one leg arteries or artery grafts	38	38	$52.47	$20.95
93922 Ultrasound study of arm and leg arteries	35	35	$27.23	$11.22
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	31	31	$84.90	$35.31
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	31	31	$290.97	$125.37
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	30	30	$48.47	$20.13
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	26	26	$124.81	$52.42
76706 Ultrasound scan of abdominal aorta	21	21	$67.86	$25.05
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	20	$210.33	$92.17
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	19	19	$84.63	$35.32
93979 Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan	19	19	$53.63	$21.27
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	19	19	$186.58	$77.49
93925 Ultrasound of leg arteries or artery grafts	17	17	$85.53	$35.34
93970 Ultrasound study of arm or leg veins with compression and maneuvers	14	14	$74.57	$31.35
76706 Ultrasound scan of abdominal aorta	12	12	$67.00	$25.05

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	232	225	$48.00	$20.22
93970 Ultrasound study of arm or leg veins with compression and maneuvers	151	149	$74.00	$31.63
93922 Ultrasound study of arm and leg arteries	113	100	$27.00	$11.29
93880 Ultrasound of both sides of head and neck blood flow	78	76	$86.00	$36.82
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	39	39	$171.31	$78.52
93922 Ultrasound study of arm and leg arteries	37	35	$27.00	$11.38
76706 Ultrasound scan of abdominal aorta	37	37	$67.00	$25.61
93880 Ultrasound of both sides of head and neck blood flow	35	34	$92.94	$39.75
93926 Ultrasound of one leg arteries or artery grafts	33	29	$52.00	$21.39
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	30	30	$48.00	$20.42
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	21	21	$124.00	$53.05
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	19	18	$84.00	$36.16
76706 Ultrasound scan of abdominal aorta	18	18	$67.00	$25.57
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	17	16	$84.00	$36.15
93925 Ultrasound of leg arteries or artery grafts	17	17	$85.00	$36.45
99213 Established patient office or other outpatient visit, typically 15 minutes	14	14	$118.93	$63.20
93979 Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan	14	14	$53.00	$22.26
93970 Ultrasound study of arm or leg veins with compression and maneuvers	13	13	$74.00	$32.05
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	12	11	$124.00	$53.16
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$272.00	$127.19
93925 Ultrasound of leg arteries or artery grafts	11	11	$85.00	$36.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	176	169	$48.00	$20.57
93970 Ultrasound study of arm or leg veins with compression and maneuvers	119	118	$74.00	$31.35
93922 Ultrasound study of arm and leg arteries	114	107	$27.00	$11.78
93880 Ultrasound of both sides of head and neck blood flow	81	81	$86.00	$37.06
76706 Ultrasound scan of abdominal aorta	43	43	$67.00	$25.61
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	38	37	$58.58	$25.56
93922 Ultrasound study of arm and leg arteries	37	37	$41.76	$16.98
93880 Ultrasound of both sides of head and neck blood flow	36	36	$142.81	$62.26
93926 Ultrasound of one leg arteries or artery grafts	35	34	$52.00	$22.34
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	34	34	$84.00	$36.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	30	30	$159.00	$79.27
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	25	25	$113.76	$48.64
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	21	21	$124.00	$53.85
99213 Established patient office or other outpatient visit, typically 15 minutes	17	16	$98.47	$64.25
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	16	16	$255.63	$129.05
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	15	15	$151.33	$95.04
93925 Ultrasound of leg arteries or artery grafts	15	15	$85.00	$36.61
76706 Ultrasound scan of abdominal aorta	13	13	$82.08	$32.00

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	200	195	$48.00	$21.60
93922 Ultrasound study of arm and leg arteries	106	99	$27.00	$12.01
93970 Ultrasound study of arm or leg veins with compression and maneuvers	102	102	$74.00	$33.61
93880 Ultrasound of both sides of head and neck blood flow	91	90	$86.00	$38.89
93880 Ultrasound of both sides of head and neck blood flow	47	47	$149.00	$66.91
93922 Ultrasound study of arm and leg arteries	46	46	$66.13	$27.21
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	45	45	$157.00	$73.00
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	41	39	$84.00	$37.17
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	40	40	$63.08	$28.32
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	31	31	$124.00	$56.03
76706 Ultrasound scan of abdominal aorta	30	30	$67.00	$27.12
99213 Established patient office or other outpatient visit, typically 15 minutes	25	23	$96.00	$49.51
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	24	23	$122.00	$55.00
93926 Ultrasound of one leg arteries or artery grafts	22	20	$52.00	$23.53
36821 Relocation of arm vein with connection to arm artery, open procedure	19	17	$1484.00	$624.83
93990 Ultrasound of dialysis access	18	16	$52.00	$22.29
76706 Ultrasound scan of abdominal aorta	17	17	$67.00	$27.04
93925 Ultrasound of leg arteries or artery grafts	17	17	$85.00	$35.94
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	15	15	$184.00	$82.98
37252 Ultrasound evaluation of blood vessel with review by radiologist, initial vessel	13	12	$206.00	$86.76
93970 Ultrasound study of arm or leg veins with compression and maneuvers	12	12	$101.25	$46.01

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	293	279	$41.34	$21.68
93922 Ultrasound study of arm and leg arteries	188	177	$22.45	$11.96
93970 Ultrasound study of arm or leg veins with compression and maneuvers	163	159	$62.12	$33.33
93880 Ultrasound of both sides of head and neck blood flow	112	111	$74.25	$38.57
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	77	76	$72.35	$37.94
93880 Ultrasound of both sides of head and neck blood flow	63	62	$146.27	$67.03
93926 Ultrasound of one leg arteries or artery grafts	57	49	$43.95	$23.46
93922 Ultrasound study of arm and leg arteries	54	49	$43.37	$19.01
76706 Ultrasound scan of abdominal aorta	50	50	$75.80	$26.52
99213 Established patient office or other outpatient visit, typically 15 minutes	50	46	$95.26	$49.20
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	48	48	$161.63	$72.86
93925 Ultrasound of leg arteries or artery grafts	34	34	$73.47	$37.35
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	33	33	$155.39	$54.21
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	30	30	$55.67	$27.81
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	29	27	$120.72	$56.80
93970 Ultrasound study of arm or leg veins with compression and maneuvers	25	24	$62.04	$33.44
93990 Ultrasound of dialysis access	24	21	$45.33	$23.37
93926 Ultrasound of one leg arteries or artery grafts	19	19	$90.79	$39.41
36821 Relocation of arm vein with connection to arm artery, open procedure	19	17	$1607.79	$617.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	18	18	$146.56	$75.96
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	16	16	$244.56	$93.87
76937 Ultrasonic guidance for blood vessel access	15	15	$37.00	$14.09
93924 Ultrasound study of arteries of both legs at rest and exercise	15	15	$46.07	$23.79
99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes	13	13	$23.31	$11.96
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$241.54	$123.80
G0365 Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)	12	12	$25.00	$11.83
76706 Ultrasound scan of abdominal aorta	11	11	$75.18	$26.84
99221 Initial hospital inpatient care per day, typically 30 minutes	11	11	$183.27	$96.96
75710 Radiological supervision and interpretation of imaging of artery of one arm or leg	11	11	$145.18	$82.62

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	302	292	$40.00	$21.27
93922 Ultrasound study of arm and leg arteries	191	177	$22.82	$11.85
93970 Ultrasound study of arm or leg veins with compression and maneuvers	187	180	$61.00	$32.67
93880 Ultrasound of both sides of head and neck blood flow	168	166	$72.00	$37.74
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	76	74	$71.00	$36.94
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	72	72	$163.00	$72.29
99213 Established patient office or other outpatient visit, typically 15 minutes	55	47	$95.00	$48.48
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	42	42	$161.00	$54.47
93880 Ultrasound of both sides of head and neck blood flow	39	39	$81.85	$42.12
93926 Ultrasound of one leg arteries or artery grafts	39	37	$51.00	$23.12
93922 Ultrasound study of arm and leg arteries	38	38	$30.26	$14.68
76706 Ultrasound scan of abdominal aorta	36	36	$77.00	$26.47
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	33	33	$40.00	$21.47
93925 Ultrasound of leg arteries or artery grafts	24	24	$71.00	$36.73
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	22	22	$102.73	$50.30
93970 Ultrasound study of arm or leg veins with compression and maneuvers	19	19	$61.00	$32.91
93990 Ultrasound of dialysis access	17	16	$44.00	$23.03
36821 Relocation of arm vein with connection to arm artery, open procedure	15	15	$1652.00	$621.37
93924 Ultrasound study of arteries of both legs at rest and exercise	15	15	$45.00	$23.41
99221 Initial hospital inpatient care per day, typically 30 minutes	14	14	$180.00	$95.56
75710 Radiological supervision and interpretation of imaging of artery of one arm or leg	14	13	$139.00	$81.46
76706 Ultrasound scan of abdominal aorta	13	13	$91.15	$31.07
G0365 Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)	13	13	$25.00	$11.64
93931 Ultrasound of one arm arteries or artery grafts	12	11	$44.00	$23.41
99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes	12	12	$23.00	$11.96
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	12	12	$161.00	$55.37
76937 Ultrasonic guidance for blood vessel access	12	12	$37.00	$13.86

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	208	202	$40.00	$21.05
93970 Ultrasound study of arm or leg veins with compression and maneuvers	183	176	$61.00	$32.97
93922 Ultrasound study of arm and leg arteries	156	148	$22.00	$11.94
93880 Ultrasound of both sides of head and neck blood flow	138	138	$72.00	$37.99
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	75	75	$150.39	$72.00
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	74	73	$71.00	$37.66
93880 Ultrasound of both sides of head and neck blood flow	53	53	$72.00	$38.23
93922 Ultrasound study of arm and leg arteries	47	45	$22.00	$11.95
93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	45	45	$40.00	$21.23
99213 Established patient office or other outpatient visit, typically 15 minutes	41	37	$95.00	$48.34
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	39	38	$161.00	$54.25
93926 Ultrasound of one leg arteries or artery grafts	37	36	$43.00	$23.07
93925 Ultrasound of leg arteries or artery grafts	34	34	$71.00	$37.64
76706 Ultrasound scan of abdominal aorta	30	30	$77.00	$26.53
36821 Relocation of arm vein with connection to arm artery, open procedure	23	22	$1652.00	$583.39
93970 Ultrasound study of arm or leg veins with compression and maneuvers	21	21	$61.00	$33.18
99221 Initial hospital inpatient care per day, typically 30 minutes	19	18	$180.00	$95.38
93978 Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts	18	18	$71.00	$37.69
93924 Ultrasound study of arteries of both legs at rest and exercise	15	15	$45.00	$23.70
93926 Ultrasound of one leg arteries or artery grafts	14	12	$43.00	$23.09
93975 Complete ultrasound of abdomen and pelvis artery and vein blood flow	13	13	$161.00	$55.16
35301 Removal of blood clot and portion of artery of neck	12	12	$2101.28	$785.23
93925 Ultrasound of leg arteries or artery grafts	11	11	$71.00	$37.73
93931 Ultrasound of one arm arteries or artery grafts	11	11	$44.00	$22.80

Medical Specialties & State Licenses

Surgery - Vascular Surgery Primary Specialty

NUCC Taxonomy Code: 2086S0129X

State License ID M-9277

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

Hospital & Practice Group Affiliations

St Lukes Clinic-Treasure Valley Llc

100 E Bannock St, Boise, ID 837126241

Phone: 2083812983

St Lukes Clinic-Treasure Valley Llc

608 W Hays St, Boise, ID 837025511

Phone: 2083815970

St Lukes Clinic-Treasure Valley Llc

333 N 1st St, Boise, ID 837026132

St Lukes Clinic-Treasure Valley Llc

610 W Hays St, Boise, ID 837025511

Phone: 2083815970

St Lukes Clinic-Treasure Valley Llc

190 E Bannock St, Boise, ID 837126241

Phone: 2083819384

St Lukes Clinic-Treasure Valley Llc

520 S Eagle Rd, Meridian, ID 836426351

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

27 Associated Practitioners

Dr. Andrew Mesher , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1003131509

Doctor of Medicine (M.D.)

Dr. Graham Donald , MD

Surgery - Vascular Surgery

NPI 1043527286

Doctor of Medicine (M.D.)

Dr. Ashley Morgan , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1073871042

Doctor of Medicine (M.D.)

Dr. Philippe Masser , MD

Surgery - Vascular Surgery

NPI 1104878446

Doctor of Medicine (M.D.)

Megan Brown , PA-C

Physician Assistant - Surgical

NPI 1124377338

Physician Assistant (Certified)

Dr. Alexis Graham , MD

Surgery - Vascular Surgery

NPI 1124418447

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active August 29, 2013

NPI status registered as active in NPPES database

📍

Updated Practice Location August 29, 2013

Registered at 333 N 1ST ST, #280, BOISE, ID 837026100 (Tel: 2083456545)

📍

Updated Business Mailing Address August 29, 2013

Registered at 190 E BANNOCK ST, BOISE, ID 837126241 (Tel: 2083456545)

👤

Provider Name / Credentials Updated August 29, 2013

Recorded as BRIAN MATTESON, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 29, 2013

Surgery (License #M-9277 in ID)

🟢

Initial NPI Registration & Enumeration May 16, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1609828003

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 16, 2006

Last Update: August 29, 2013

Sole Proprietor: No

Update or Correct Profile

Mailing Address

190 E Bannock St

Boise, ID 837126241

Phone: 2083456545

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.