Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blake D Niederhauser, MD

Individual provider Diagnostic Radiology Physician · NPI 1578726683

Blake D Niederhauser, MD is a Diagnostic Radiology in Boise, Idaho. Graduated from Vanderbilt University School of Medicine in 2008, 18 years ago. Practices with Boise Radiology Group PLLC, a 63-clinician group and accepts Medicare assignment. Licensed in Idaho and Minnesota.

Years since qualifying
18
Trained at
Vanderbilt University School of Medicine
Licensed in
ID, MN
In the registry since
2008
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

190 E Bannock St
Boise, ID 83712-6241
Phone: (208) 381-2094
Fax: (208) 381-1791
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence M-12384 (ID)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 104451 (MN)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 52314 (MN)

Record details

NPI number1578726683
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 8, 2008
Last updated in NPPESJanuary 10, 2018
Mailing addressPo Box 1108, Corvallis, OR 97339-1108

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolVANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Graduated 2008 (18 years in practice)
Group practice Boise Radiology Group Pllc — 63 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

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