1. Home
  2. Directory
  3. Idaho
  4. Boise
  5. Clinic Center
  6. NPI Profile

BOISE ENDOSCOPY CENTER LLC
NPI 1114912102
Clinic/Center - Ambulatory Surgical in Boise, ID

Active since September 15, 2005CLIA 13D0521568 · Waiver
425 W BANNOCK ST, BOISE, ID 83702(208) 342-7169(208) 368-0863 Get Directions Write a Review

NPPES record last updated: April 18, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 18, 2026, Dec 8, 2022, Jul 22, 2019 (3 updates tracked since 2019).

About Boise Endoscopy Center Llc NPPES

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

BOISE ENDOSCOPY CENTER LLC (NPI 1114912102) is a healthcare organization registered as an ambulatory surgical in Boise, Idaho and active in the NPI registry since September 2005. The organization holds a CLIA Waiver certificate valid through December 9, 2027 and lists Robert Lockwood, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1114912102
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameBOISE ENDOSCOPY CENTER LLC
Location Address425 W BANNOCK STBoise, ID 83702-6035
Mailing Address425 W Bannock StBoise, ID 83702-6035 · (208) 342-7169 · Fax (208) 343-5031
Phone(208) 342-7169
Fax(208) 368-0863
Organization SubpartNo
Authorized OfficialRobert LockwoodAuthorized Official · (208) 342-7169
Enumeration DateSeptember 15, 2005
Last NPPES UpdateApril 18, 20263 updates tracked since enumeration
NPPES CertifiedApril 18, 2026
✔ NPI 1114912102 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
License✔ Licensed in ID · 1870273
425 W BANNOCK ST, Boise, ID 83702
Open in Google Maps ↗

Other Identifiers 3

Other000010005291ID · Blue Shield Of Idaho
Other04580ID · Blue Cross Of Idaho
Medicaid805944300ID

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Molina Healthcare, PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Boise Endoscopy Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

16

Medicare enrollment records show 16 clinicians reassign Medicare billing to Boise Endoscopy Center LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 7 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 2

Gastroenterology14
Internal Medicine2

Clinicians, nearest first (16)

Christopher Hammerle, MD
Gastroenterology
NPI 1740336361
425 W BANNOCK ST
Boise, ID 83702
(208) 343-6458
✔ PECOS✔ Accepts MedicareSame address
Robert Lockwood, M.D.
Gastroenterology
NPI 1588954101
425 W BANNOCK ST
Boise, ID 83702
(208) 343-6458
✔ PECOS✔ Accepts MedicareSame address
Matthew Sericati, MD
Gastroenterology
NPI 1194871871
425 W BANNOCK ST
Boise, ID 83702
(208) 343-6458
✔ PECOS✔ Accepts MedicareSame address
David Wood, M.D.
Gastroenterology
NPI 1659367993
425 W BANNOCK ST
Boise, ID 83702
(208) 343-6458
✔ PECOS✔ Accepts MedicareSame address
Elsbeth Jensen-Otsu, MD
Gastroenterology
NPI 1366731259
500 W. FORT ST. # 111
Boise, ID 83702
(208) 422-1315
✔ PECOS✔ Accepts Medicare0.6 mi
Akshay Gupta, M.D.
Gastroenterology
NPI 1255542338
2235 E GALA ST
Meridian, ID 83642
(208) 887-3724
✔ PECOS✔ Accepts Medicare8.6 mi
Brian Story, MD
Gastroenterology
NPI 1851551089
2235 E GALA ST
Meridian, ID 83642
(208) 887-3724
✔ PECOS✔ Accepts Medicare8.6 mi
John Dever, MD
Internal Medicine
NPI 1093918724
875 S VANGUARD WAY STE 310
Meridian, ID 83642
(208) 463-3000
✔ PECOS✔ Accepts Medicare12 mi
Kirsten Morigeau, MD
Gastroenterology
NPI 1811123961
1216 GARRITY BLVD
Nampa, ID 83687
(128) 343-6458
✔ PECOS✔ Accepts Medicare18 mi
Bonnie Waite, M.D., CHARTERED
Gastroenterology
NPI 1770578759
1216 GARRITY BLVD
Nampa, ID 83687
(208) 343-6458
✔ PECOS✔ Accepts Medicare18 mi
Victoria Jaeger, DO
Gastroenterology
NPI 1770938318
1200 GARRITY BLVD
Nampa, ID 83687
(208) 343-6458
✔ PECOS✔ Accepts Medicare18 mi
Erin Mccoy, M.D.
Gastroenterology
NPI 1700010873
1200 GARRITY BLVD
Nampa, ID 83687
(208) 343-6458
✔ PECOS✔ Accepts Medicare18 mi
Justin Tomal, M.D.
Gastroenterology
NPI 1093129751
1200 GARRITY BLVD
Nampa, ID 83687
(208) 343-6458
✔ PECOS✔ Accepts Medicare18 mi
Jason Farrell, DO
Internal Medicine
NPI 1982166526
100 N ACADEMY AVE
Danville, PA 17822
(570) 271-6787
✔ PECOS✔ Accepts Medicare2,018 mi
David Arner, M.D.
Gastroenterology
NPI 1851414262
1031 LOFTIS BLVD STE 201
Newport News, VA 23606
(757) 736-9850
✔ PECOS✔ Accepts Medicare2,123 mi
Oswaldo Bisbal, MD
Gastroenterology
NPI 1487686242
77 BATES ST STE 202
Lewiston, ME 04240
(207) 784-5784
✔ PECOS✔ Accepts Medicare2,267 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D0521568

Boise Endoscopy Center LLC · Boise, ID
Active · expires Dec 9, 2027
CLIA Number13D0521568
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateDecember 10, 2025
Certificate Expiration DateDecember 9, 2027
Laboratory DirectorRobert A. Lockwood
Laboratory Phone(208) 342-7169
Laboratory LocationBoise Endoscopy Center LLC425 W Bannock St, Boise, ID 83702
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
376 services373 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
262 services255 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
151 services150 patients
Insertion of guide wire with dilation of esophagus using a flexible endoscope 43248
This is a procedure where a thin tube, called an endoscope, is gently passed through your mouth into your esophagus. A guide wire is then inserted to help widen any narrow areas. This helps improve swallowing and reduce discomfort.
116 services114 patients
Colorectal cancer screening; colonoscopy on individual at high risk G0105
Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.
84 services84 patients
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121
Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.
48 services48 patients

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 Boise Endoscopy Center LLC's NPI number?

The NPI number for Boise Endoscopy Center LLC is 1114912102. It was assigned to this organization in the NPPES registry on September 15, 2005.

Where is Boise Endoscopy Center LLC located?

Boise Endoscopy Center LLC is located at 425 W Bannock St, Boise, ID 83702. The listed phone number is (208) 342-7169.

What is Boise Endoscopy Center LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Boise Endoscopy Center LLC enrolled in Medicare?

Yes. Boise Endoscopy Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Boise Endoscopy Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 16 clinicians in 2 Medicare specialties reassign their Medicare billing to Boise Endoscopy Center LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Gastroenterology (14) and Internal Medicine (2). Of these, 4 practice at this address and 7 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Boise Endoscopy Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D0521568) is associated with this NPI, valid through December 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Boise Endoscopy Center LLC accept?

Health plans from Moda Health Plan, Inc., Molina Healthcare, PacificSource Health Plans and Select Health list Boise Endoscopy Center LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Boise Endoscopy Center LLC was last updated on April 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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.