NPIMap

Individual provider Active NPI

Tucker Jeppson, DO

  • Diagnostic Radiology Physician
  • Moscow, ID
National Provider Identifier
1104455922
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
9861270 Issued in ID
Practice address
220 W 3Rd St
Moscow, ID 83843-2203
Phone
(208) 882-8369
NPI assigned
Apr 3, 2020
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 9861270 ID Primary

Addresses

Primary practice location

220 W 3Rd St
Moscow, ID 83843-2203

Mailing address

PO Box 9583
Moscow, ID 83843-0177
Phone (208) 882-8369

Other practice location 1

1200 W Fairview St
Colfax, WA 99111-9552
Phone (208) 882-8369

Other practice location 2

701 Lewiston St
Cottonwood, ID 83522-9750
Phone (208) 962-3251

Other practice location 3

301 Cedar St
Orofino, ID 83544-9029
Phone (208) 882-8369

Other practice location 4

20201 Crawford Ave
Olympia Fields, IL 60461-1010
Phone (708) 747-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250804001238 WA Practitioner - Diagnostic Radiology 0648788455 Reassigns benefits to 1 organization
I20250805001658 ID Practitioner - Diagnostic Radiology 0648788455 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Pacific NW Un of HS, Col of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palouse Imaging Consultants, PLLCGroup PAC ID 9234269648, 3 clinicians
Clearwater Valley Hospital and ClinicsGroup PAC ID 0547173346, shared by 4 NPIs, 27 clinicians
St Marys Hospital IncGroup PAC ID 5092773168, 22 clinicians

Practice addresses (Care Compare)

1200 W Fairview St
Colfax, WA 99111-9552
Phone (509) 397-3435

301 Cedar St
Orofino, ID 83544-9029
Phone (208) 476-5777

700 S Main St
Moscow, ID 83843-3056
Phone (208) 882-4511

701 Lewiston St
Cottonwood, ID 83522-9750
Phone (208) 962-3251

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9861270IDMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clearwater Valley Hospital & Clinics Inc. CurrentSince Sep 8, 2025 Accepting new patients
Clearwater Valley Hospital & Clinics Inc. CurrentSince Sep 8, 2025 Accepting new patients
Clearwater Valley Hospital & Clinics Inc. CurrentSince Nov 9, 2025 Accepting new patients
St. Mary's Hospital Inc CurrentSince Nov 9, 2025 Accepting new patients
Palouse Imaging Consultants, PLLC Diagnostic Radiology CurrentSince Jul 1, 2025 Accepting new patients
St. Mary's Hospital Inc CurrentSince Nov 9, 2025 Accepting new patients

Locations

701 Lewiston St
Cottonwood, ID 83522
Phone (208) 962-3251

220 W 3rd St
Moscow, ID 83843
Phone (208) 882-8369

700 S Main St
Moscow, ID 83843
Phone (208) 746-7555

301 Cedar St
Orofino, ID 83544
Phone (208) 476-4555

1200 W Fairview St
Colfax, WA 99111
Phone (509) 397-3435

Interoperability endpoints

  • Direct secure messaging: tjeppson480301@direct.franciscanalliance.org

Organizations & group practices 7

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1104455922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9583",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838430177",
            "telephone_number": "208-882-8369",
            "fax_number": "208-882-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W 3RD ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432203",
            "telephone_number": "208-882-8369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 W Fairview St",
            "address_purpose": "LOCATION",
            "city": "Colfax",
            "state": "WA",
            "postal_code": "991119552",
            "country_code": "US",
            "telephone_number": "208-882-8369",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Lewiston St",
            "address_purpose": "LOCATION",
            "city": "Cottonwood",
            "state": "ID",
            "postal_code": "835229750",
            "country_code": "US",
            "telephone_number": "208-962-3251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Cedar St",
            "address_purpose": "LOCATION",
            "city": "Orofino",
            "state": "ID",
            "postal_code": "835449029",
            "country_code": "US",
            "telephone_number": "208-882-8369",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20201 Crawford Ave",
            "address_purpose": "LOCATION",
            "city": "Olympia Fields",
            "state": "IL",
            "postal_code": "604611010",
            "country_code": "US",
            "telephone_number": "708-747-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEPPSON",
        "first_name": "TUCKER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-03",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "9861270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

Verify at the official NPI Registry.