Jenny Rickell Willmore, P.A.-C.
Individual provider Active NPI Physician Assistant · Saint Anthony, ID
NPI 1003992140 · NPPES record last updated Sep 25, 2012
Key facts
- NPI
- 1003992140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA-519 (ID)
- Practice address
- 605 Maple Ave
Saint Anthony, ID 83445-5529 - Phone
- (208) 624-4002
- Fax
- (208) 624-4409
- NPI assigned
- Oct 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Madison Memorial Hospital
Practice addresses (Care Compare)
450 E Main St
Reburg, ID 83440-2048
Phone (208) 359-6516
Hospital & facility affiliations
- Teton Valley Hospital
- Madison Memorial Hospital
- Mountain View Hospital
- Eastern Idaho Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050223000366 | ID | Practitioner - Physician Assistant | 6800849571 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-519 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teton Valley Health Care Inc | Current |
Accepting new patients | |
| Madison Co Memorial Hospital | Current | Accepting new patients | |
| Mountain View Hospital LLC | Current |
Accepting new patients | |
| Teton Valley Health Care, Inc | Current |
Accepting new patients | |
| Teton Valley Health Care Inc | Family Medicine | Current |
Accepting new patients |
| Medical Imaging Associates of Idaho Falls, Inc | Past | Accepting new patients | |
| Madison Co Memorial Hospital | Family Medicine | Past | Accepting new patients |
Locations
283 N 1st St
Driggs, ID 83422
Phone (208) 354-2302
120 E Howard St
Driggs, ID 83422
Phone (208) 354-2302
2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686
450 E Main St
Rexburg, ID 83440
Phone (208) 356-3691
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/d61ab3e4-55bb-4859-99e6-22c413b48f2a/
- willmoje@direct.madisonmemorial.org
- jennifer.willmore.1@15468.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-519 | ID | Yes |
Addresses
Primary practice location
605 Maple Ave
Saint Anthony, ID 83445-5529
Mailing address
605 Maple Ave
Saint Anthony, ID 83445-5529
Phone (208) 624-4402
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807122700 | Medicaid | ID |
Other providers in Saint Anthony, ID
- Desiree Wade
- Shauna A Wasden
- Spencer Emery Webb
- West Jefferson Family Health
- Trevor Glade Wilde
- Ryan G Willmore
- Beth Winegar
- Tara Lyanne Wood
- Bryce S Woodfield
- Bryce David Wylie
All providers in Saint Anthony, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.