1. Home
  2. Directory
  3. Idaho
  4. Boise
  5. Family Medicine
  6. NPI Profile

DR. CHARLES MICHAEL DAVIS DO
NPI 1104877364
Family Medicine in Boise, ID

Active since May 13, 2006PECOS Enrolled
500 W FORT ST, BOISE, ID 83702(208) 422-1000 Get Directions Write a Review

NPPES record last updated: February 25, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 25, 2022, Jun 12, 2020 (2 updates tracked since 2020).

About Dr. Charles Michael Davis Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHARLES MICHAEL DAVIS DO (NPI 1104877364) is an individual family medicine provider in Boise, Idaho, licensed in Idaho (O--0448) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104877364
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. CHARLES MICHAEL DAVISCredential: DO
Location Address500 W FORT STBoise, ID 83702-4501
Mailing Address500 W. Fort St., # 111Boise, ID 83702 · (208) 422-1325 · Fax (208) 422-1319
Phone(208) 422-1000
Sole ProprietorNo
Enumeration DateMay 13, 2006
Last NPPES UpdateFebruary 25, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 25, 2022
✔ NPI 1104877364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in ID · O--0448
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
500 W FORT ST, Boise, ID 83702
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Charles Michael Davis Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83702 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.13 typical visit price
range $52.44 – $160.17
Typical copayment $20.28 (range $13.11 – $40.04)
Most-billed visit code 99203
Established Patient
$93.26 typical visit price
range $16.68 – $130.93
Typical copayment $23.31 (range $4.17 – $32.73)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JESSICA ANN BERNOTSKI RDH
Dental Hygienist
500 W FORT ST
BOISE, ID 83702
Ada County (208) 422-1000
ROBERT FISHER
Registered Nurse (Gastroenterology)
500 W FORT ST
BOISE, ID 83702
Ada County (208) 422-1092
LUKE DANIEL HANSEN MD
Psychiatry & Neurology (Psychiatry)
500 W FORT ST
BOISE, ID 83702
Ada County (208) 422-1000
CHRISTOPHER M GUTIERREZ
Registered Nurse (Gastroenterology)
500 W FORT ST
BOISE, ID 83702
Ada County (208) 422-1000
DR. MICHAEL GLOVER M.D.
Orthopaedic Surgery (Orthopaedic Surgery of the Spine)
500 W FORT ST, MAIL CODE #112
BOISE, ID 83702
Ada County (208) 422-1000
DR. ANN DECKER TROTTER PHD
Psychologist (Clinical)
500 W FORT ST
BOISE, ID 83702
Ada County (208) 422-1000
REBECCA COTTERELL RN-BC, BSN
Registered Nurse
500 W FORT ST
BOISE, ID 83702
Ada County (208) 422-1000
PHILIP RESIN ELACKATT RN
Registered Nurse (Pain Management)
500 W FORT ST
BOISE, ID 83702
Ada County (986) 256-1766

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Davis's NPI number?

The NPI number for Charles Davis is 1104877364. It was assigned to this individual provider in the NPPES registry on May 13, 2006.

Where is Charles Davis located?

Charles Davis practices at 500 W Fort St, Boise, ID 83702. The listed phone number is (208) 422-1000.

What is Charles Davis's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Charles Davis enrolled in Medicare?

Yes. Charles Davis is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Charles Davis was last updated on February 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.