SURGICARE CENTER OF IDAHO, LLC
NPI 1114923471
Clinic/Center - Ambulatory Surgical in Boise, ID
NPI Status: Active since June 22, 2005
Contact Information
360 E MALLARD DR
STE 125
BOISE, ID
ZIP 83706
Phone: (208) 336-8700
Fax: (208) 426-0902
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 13D1019855
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 12-01-2027
About SURGICARE CENTER OF IDAHO, LLC
This page provides the complete NPI Profile along with additional information for Surgicare Center Of Idaho, Llc, a provider established in Boise, Idaho operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1114923471 assigned on June 2005. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 10 years ago. The authorized official of this NPI record is Mr. Louis Pennow Mba (Director)
- NPI
- 1114923471
- Provider Name
- SURGICARE CENTER OF IDAHO, LLC
- Entity Type
- Organization
- Location Address
- 360 E MALLARD DR STE 125 BOISE, ID 83706
- Location Phone
- (208) 336-8700
- Location Fax
- (208) 426-0902
- Mailing Address
- 360 E MALLARD DR STE 125 BOISE, ID 83706
- Mailing Phone
- (208) 336-8700
- Mailing Fax
- (208) 426-0902
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-22-2005
- Last Update Date
- 10-10-2016
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QS0132X | Ambulatory Health Care Facilities | Clinic/Center |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
- Core Bronze HSA 10600 - EPO
- Core Bronze HSA 7500 - EPO
- Core Bronze HSA 8300 - EPO
- Core Gold 1500 - EPO
- Core Gold 3000 - EPO
- Core Silver 3500 - EPO
- Core Silver 4500 - EPO
- Core Silver 5000 - EPO
- Core Silver 7500 - EPO
- Core Standard Expanded Bronze HSA - EPO
- Core Standard Gold - EPO
- Core Standard Silver - EPO
- PacificSource Oregon Standard Bronze HSA Plan Core - EPO
- PacificSource Oregon Standard Gold Plan Core - EPO
- PacificSource Oregon Standard Silver Plan Core - EPO
- HSA Qualified 7500 Bronze - Choice Network - EPO
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1870391 | MEDICARE ID-TYPE UNSPECIFIED (04) | ID | MEDICARE |
| 490004468 | MEDICARE PIN (08) | ID | |
| 273390 | MEDICAID (05) | ID |
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Complex removal of cataract with insertion of prosthetic lens
Creation of eye fluid drainage tracts in iris using a laser, per session
Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye
Laser repair to improve eye fluid flow
Removal of cataract with insertion of prosthetic lens
Removal of recurring cataract in lens capsule using a laser
Repair tear duct opening by heat, tying, or laser surgery
This procedure involves removing a cloudy lens (cataract) from your eye and replacing it with a clear, artificial lens. It helps restore vision that has been affected by the cataract. The operation is usually done under local anesthesia.
This service was performed 83 times for 73 patientsThis procedure uses a laser to create small drainage tracts in the iris, the colored part of your eye. This helps excess fluid escape, reducing pressure in the eye that can cause glaucoma. It's performed in sessions.
This service was performed 27 times for 15 patientsThis is a two-part eye procedure. First, a cloudy lens (cataract) is removed from its outer layer and replaced with an artificial lens to improve vision. Second, a drainage device is inserted into the front part of the eye to manage fluid levels, preventing pressure build-up.
This service was performed 42 times for 28 patientsLaser repair to improve eye fluid flow is a procedure aimed at treating glaucoma. A laser is used to create a small hole in the eye's drainage system, allowing fluid to flow out more easily. This helps to lower the pressure inside the eye, reducing the risk of vision loss.
This service was performed 69 times for 44 patientsThis is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
This service was performed 921 times for 578 patientsThis procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.
This service was performed 549 times for 406 patientsThis procedure involves fixing a blocked tear duct. A specialist may use heat, sutures, or laser surgery to open up the tear duct and allow tears to drain normally. This can alleviate symptoms such as excessive tearing or infection. It's a common and safe procedure.
This service was performed 34 times for 28 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D1019855
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- December 02, 2025
- Certificate Expiration Date
- December 01, 2027
- Laboratory Director
- RYAN T. BARRETT
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Surgicare Center Of Idaho, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1114923471, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 6 providers are registered at the same or a nearby location.
BOISE, ID 83706
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114923471, enumerated as an "organization" on June 22, 2005.
The provider is located at 360 E MALLARD DR STE 125 BOISE, ID 83706 and the phone number is (208) 336-8700.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: Moda Health Plan, Inc., PacificSource Health. Please consult your insurance carrier or call the provider to verify.
