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Samantha Marie Nizich

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

300 E Jefferson St, Boise, ID 83712-6246

PECOS Enrollment

This provider is enrolled in PECOS as SAMANTHA NIZICH.

Based on the most recent information from CMS, provider Samantha Marie Nizich is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1659244127
Provider Type
Individual
Full Name
Nizich, Samantha Marie
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
9/29/2025
Last Updated
1/21/2026

Contact Information

Practice Location

300 E Jefferson St, Boise, ID 83712-6246

(208) 322-1680

(208) 322-1695

Mailing Location

190 E Bannock St, Boise, ID 83712-6241

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 5171784 Idaho

Samantha Marie Nizich

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Nielson, David E

Smith, Samantha Jo

Wilson, Eleanor Rose

Cole-Riccardi, Michelle Denise

Conlin, Cheryl Ann

Johnson, Cody

Jessup, Alice Rachel

Mcdowell, Elizabeth

Newman, Nicholas Cary

Lynn, Michael Brian