NPIMap

Individual provider Active NPI

Jeffrey C Haskell X, MD

  • Family Medicine Physician
  • Arco, ID
National Provider Identifier
1073535506
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M6181 Issued in ID
Practice address
313 E Era Ave
Arco, ID 83213-8802
Phone
(208) 569-4008
Fax
(208) 527-8265
NPI assigned
Jul 24, 2006
Last updated
Feb 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ph.D. Medical Genetics 170100000X M6181 ID
Family Medicine Physician 207Q00000X M6181 ID Primary
Pain Medicine Physician 208VP0000X M6181 ID

Addresses

Primary practice location

313 E Era Ave
Arco, ID 83213-8802

Mailing address

2470 Jafer CT
Idaho Falls, ID 83404-5587
Phone (208) 715-9990

Other identifiers 1

IdentifierTypeStateIssuer
003739200MedicaidID

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
I20110218000114 ID Practitioner - Family Practice 6709067135 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nevada School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ridgeline Medical LLCGroup PAC ID 5092054551, 6 clinicians

Practice addresses (Care Compare)

2470 Jafer CT
Idaho Falls, ID 83404-5587
Phone (208) 715-9990

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M6181IDMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adolpho Enterprise LLC. Family Medicine CurrentSince Jun 9, 2024 Accepting new patients
Adolpho Enterprise LLC. PastSince Jun 9, 2024 Accepting new patients
Tacoma Emergency Medicine Associates PC Emergency Medicine Past Accepting new patients
Northwest Emergency Physicians LLC Emergency Medicine Past Accepting new patients
William Eder MD Family Medicine Past Accepting new patients
Doctor Mom's Wholesome Health, PLLC Family Medicine PastSince Apr 14, 2015 Accepting new patients
Lost Rivers Medical Center Family Medicine Past Accepting new patients

Locations

3649 N Lakeharbor Ln
Boise, ID 83703
Phone (208) 991-4296

1301 E 17th St
Idaho Falls, ID 83404
Phone (208) 538-3122

1224 1st St S
Ste 307
Nampa, ID 83651
Phone (208) 322-5859

Organizations & group practices 8

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

Hospital & facility affiliations 1

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1073535506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 JAFER CT",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834045587",
            "telephone_number": "208-715-9990",
            "fax_number": "877-828-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 E ERA AVE",
            "city": "ARCO",
            "state": "ID",
            "postal_code": "832138802",
            "telephone_number": "208-569-4008",
            "fax_number": "208-527-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKELL",
        "first_name": "JEFFREY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "X",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "ID",
            "license": "M6181",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M6181",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "ID",
            "license": "M6181",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003739200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arco, ID

Sources for this page

Verify at the official NPI Registry.