Individual provider Active NPI

James A Davis, OD

  • Optometrist
  • Jerome, ID
National Provider Identifier
1164533485
Registry record updated Jul 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP0912 Issued in ID
Practice address
201 South Lincoln
Jerome, ID 83338-2624
Phone
(208) 324-4363
Fax
(208) 324-8948
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP0912 ID Primary

Addresses

Primary practice location

201 South Lincoln
Jerome, ID 83338-2624

Mailing address

201 South Lincoln
Jerome, ID 83338-2624
Phone (208) 324-4363

Other identifiers 1

IdentifierTypeStateIssuer
002457802MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051222000419 ID Practitioner - Optometry 7618995796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecenter PAGroup PAC ID 4486672565, 4 clinicians

Practice addresses (Care Compare)

180 1St Ave N
Ketchum, ID 83340-6129
Phone (208) 726-3363

201 S Lincoln Ave
Jerome, ID 83338-2624
Phone (208) 324-4363

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP0912IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecenter PA Optometrist CurrentSince Oct 1, 1996 Accepting new patients
Eyecenter PA Optometrist CurrentSince Oct 1, 1996 Accepting new patients
Eyecenter PA Optometrist Current Accepting new patients

Locations

201 S Lincoln Ave
Jerome, ID 83338
Phone (208) 324-4363

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280188800000",
    "number": "1164533485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SOUTH LINCOLN",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833382624",
            "telephone_number": "208-324-4363",
            "fax_number": "208-324-8948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SOUTH LINCOLN",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833382624",
            "telephone_number": "208-324-4363",
            "fax_number": "208-324-8948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JAMES",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP0912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002457802",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jerome, ID

Sources for this page

Verify at the official NPI Registry.