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

Takahisa Koide, PA

Individual provider Physician Assistant · NPI 1508514456

Takahisa Koide, PA is a Physician Assistant in Nampa, Idaho. Qualified in 2021, 5 years ago. Practices with Alliance Medical Group LLC, a 130-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

700 Caldwell Blvd
Nampa, ID 83651-1707
Phone: (208) 466-6567
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-2208 (ID)

Record details

NPI number1508514456
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 10, 2022
Last updated in NPPESMarch 10, 2022
Certification dateMarch 10, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Alliance Medical Group Llc — 130 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations10 on file with Medicare

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