NPIMap

Individual provider Active NPI

Jennifer A. Southard, M.D.

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1023216538
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-11245 Issued in ID
Practice address
6533 Emerald Street
Boise, ID 83704-8737
Phone
(208) 302-5100
Fax
(208) 302-5155
NPI assigned
Jul 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RS2000-0386 NM
Family Medicine Physician 207Q00000X M-11245 ID Primary

Addresses

Primary practice location

6533 Emerald Street
Boise, ID 83704-8737

Mailing address

3340 East Goldstone Way
Meridian, ID 83642
Phone (208) 302-5100

Other identifiers 1

IdentifierTypeStateIssuer
RS2000-0386OtherNMTRAINING LICENSE

Other names 1

  • Dr. Jennifer Ann Warner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110716000009 ID Practitioner - Family PracticePractitioner - Sports Medicine 4385812429 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of Colorado School of Medicine, Denver, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3025 W Cherry LN
Meridian, ID 83642-8531

6022 W Emerald St
Boise, ID 83704-8855
Phone (208) 367-4603

6051 W Emerald St
Boise, ID 83704-8969
Phone (208) 302-5100

6094 W Emerald St
Boise, ID 83704-8855
Phone (208) 302-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-11245IDMDFamily Medicine Physician
RS2000-0386NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc Family Medicine CurrentSince Aug 1, 2011 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Aug 1, 2011 Accepting new patients

Locations

6533 W Emerald St
Boise, ID 83704
Phone (208) 302-5200

6051 W Emerald St
Boise, ID 83704
Phone (208) 302-5100

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

4400 E Flamingo Ave
Ste 301
Nampa, ID 83687
Phone (208) 465-6900

Interoperability endpoints

  • Direct secure messaging: jsouthard1563179@direct.trinity-health.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1023216538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 EAST GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-302-5100",
            "fax_number": "208-302-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 EMERALD STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048737",
            "telephone_number": "208-302-5100",
            "fax_number": "208-302-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHARD",
        "first_name": "JENNIFER",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-05",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "RS2000-0386",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-11245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAINING LICENSE",
            "identifier": "RS2000-0386",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WARNER",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.