Jesse Tellez Hernandez, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP-1663A Issued in ID

Practice address

Building 70 Navajo Drive
Fort Hall, ID 83203

Phone

(208) 478-3987

Fax

(208) 478-4040

NPI assigned

Dec 10, 2015

Last updated

Mar 30, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Community Council of Idaho, Inc

  • Federally Qualified Health Center (FQHC)
  • Idaho Falls, ID
  • NPI 1710925250

  Corporate Director

  CMS ownership
• Community Council of Idaho, Inc.

  dba Community Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Blackfoot, ID
  • NPI 1356416861

  Corporate Director

  CMS ownership
• Community Council of Idaho, Inc.

  dba Rigby Community Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Rigby, ID
  • NPI 1710664834

  Corporate Director

  CMS ownership

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.

• Shoshone Bannock Tribes, Inc

  dba Shoshone-Bannock Community Health Center

  • Clinic/Center
  • Fort Hall, ID
  • NPI 1225414519

  TX

  Medicare reassignment
• Need-a-Nurse Medical Staffing, LLC

  dba Family Medical Clinic of Chubbuck

  • Primary Care Clinic/Center
  • Pocatello, ID
  • NPI 1003231911
  NPD (past)
• Need-a-Nurse Medical Staffing, LLC

  dba Prevention by the Ounce

  • Clinic/Center
  • Chubbuck, ID
  • NPI 1023353091
  NPD (past)
• Shoshone-Bannock Community Health Center

  dba Shoshone-Bannock Tribes

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Fort Hall, ID
  • NPI 1225570716
  NPD (past)

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1184099558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4414",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054414",
            "telephone_number": "208-219-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING 70 NAVAJO DRIVE",
            "city": "FORT HALL",
            "state": "ID",
            "postal_code": "83203",
            "telephone_number": "208-478-3987",
            "fax_number": "208-478-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELLEZ HERNANDEZ",
        "first_name": "JESSE",
        "name_prefix": "Dr.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-10",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP-1663A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shoshone Bannock Tribes, Inc (Shoshone-Bannock Community Health Center)
• Shoshone Bannock Tribes, Inc (Shoshone Bannock Clinic)
• Shoshone Bannock Tribes, Inc. (Fort Hall Fire & EMS District)
• Shoshone-Bannock Community Health Center (Shoshone-Bannock Tribes)
• Melissa D. Syria, LCPC
• Thomas John Troshynski, PHARMD
• James Fred Vook, M.D.
• Matthew J Wadsworth, LCSW

• Nurse Practitioner in Fort Hall, ID
• Providers in Fort Hall, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.