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BOISE STATE UNIVERSITY PUBLIC HEALTH CLINIC
NPI 1134905243
Clinic/Center - Community Health in Boise, ID

Active since September 05, 2023
2100 UNIVERSITY DR STE 107, BOISE, ID 83725(208) 426-1523(208) 426-2302 Get Directions Write a Review

NPPES record last updated: August 29, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 21, 2024, Aug 8, 2024, Oct 12, 2023 and 1 more (4 updates tracked since 2023).

About Boise State University Public Health Clinic NPPES

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

BOISE STATE UNIVERSITY PUBLIC HEALTH CLINIC (NPI 1134905243) is a healthcare organization registered as a community health in Boise, Idaho and active in the NPI registry since September 2023. The organization lists Stephanie Hudon, Clinical Program Director, as its authorized official.

NPPES Registry Identity

NPI1134905243
Entity TypeOrganization
Primary Taxonomy261QC1500X
Legal Business NameBOISE STATE UNIVERSITY
Location Address2100 UNIVERSITY DR STE 107Boise, ID 83725-0001
Mailing Address1910 University Dr, # Ms 1855Boise, ID 83725 · (208) 426-1523 · Fax (208) 426-2302
Phone(208) 426-1523
Fax(208) 426-2302
Organization SubpartNo
Authorized OfficialStephanie HudonClinical Program Director · (208) 995-3765
Enumeration DateSeptember 5, 2023
Last NPPES UpdateAugust 29, 20244 updates tracked since enumeration
NPPES CertifiedAugust 29, 2024
✔ NPI 1134905243 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Community HealthAmbulatory Health Care Facilities
Taxonomy Code261QC1500X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedPreventive Medicine · Public Health & General Preventive MedicineTaxonomy 2083P0901X
Also ListedPublic Health or WelfareTaxonomy 251K00000X
2100 UNIVERSITY DR STE 107, Boise, ID 83725
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Other Names 1

Doing Business AsBoise State University Public Health Clinic

Other Identifiers 1

Medicaid1134905243ID

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 State University Public Health Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Boise State University Public Health Clinic, which bills Medicare for the services this clinician delivers.

Clinician (1)

Richard Radnovich, DO
Sports Medicine
NPI 1407944655
4850 N ROSEPOINT WAY STE 100
Boise, ID 83713
(208) 939-2100
✔ PECOS8.3 mi

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

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 State University's NPI number?

The NPI number for Boise State University is 1134905243. It was assigned to this organization in the NPPES registry on September 5, 2023. The provider is doing business as Boise State University Public Health Clinic.

Where is Boise State University located?

Boise State University is located at 2100 University Dr Ste 107, Boise, ID 83725. The listed phone number is (208) 426-1523.

What is Boise State University's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Community Health, with taxonomy code 261QC1500X.

Is Boise State University enrolled in Medicare?

Yes. Boise State University is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Boise State University?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Sports Medicine) reassigns their Medicare billing to Boise State University. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Boise State University was last updated on August 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.