NPIMap

Individual provider Active NPI

Jack C Chaffin Jr., MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Boise, ID
National Provider Identifier
1104867662
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
M8872 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-2152
NPI assigned
Jun 8, 2006
Last updated
Oct 13, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X M8872 ID
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X M8872 ID Primary

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

PO Box 9589
Boise, ID 83707-4589
Phone (208) 472-8109

Other identifiers 1

IdentifierTypeStateIssuer
806728500MedicaidID

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
I20040210000424 ID Practitioner - Pathology 8325932577 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Loma Linda University School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8872IDMDCytopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Alphonsus Professional Medical Services LLC CurrentSince Jul 8, 2003 Accepting new patients
St Alphonsus Professional Medical Services LLC Anatomic Pathology & Clinical Pathology CurrentSince Jul 8, 2003 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Anatomic Pathology & Clinical Pathology CurrentSince Feb 26, 2022 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Feb 26, 2022 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

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

Organizations & group practices 4

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 10

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1104867662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9589",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837074589",
            "telephone_number": "208-472-8109",
            "fax_number": "208-472-8172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAFFIN",
        "first_name": "JACK",
        "middle_name": "C",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "ID",
            "license": "M8872",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "ID",
            "license": "M8872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806728500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.