Jaclyn Johnson Jolley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1520 Issued in ID

Practice address

775 Pole Line Rd W Ste 312
Twin Falls, ID 83301-5823

Phone

(208) 814-8500

Fax

(208) 814-8960

NPI assigned

Jun 20, 2017

Last updated

Jun 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Johnson Jolley Professional name

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

Merit-based Incentive Payment System (MIPS)

Final score

85.09 of 100Reported as group

Quality

77.1

Promoting interoperability

100

Improvement activities

40

Cost

73.19

Merit-based Incentive Payment System (MIPS)

Final score

92.2 of 100Reported as group

Quality

93.82

Promoting interoperability

100

Improvement activities

40

Cost

80.19

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• St Luke's Clinic LLC

  dba St Lukes Clinic - Magic Valley/Jerome

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229
  Medicare reassignment Care Compare group
• Tripp Family Medicine, Inc.

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1043578883
  Medicare reassignment
• St Luke's Magic Valley Regional Medical Center LTD

  dba St Lukes Retail Pharmacy Twin Falls

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

• St. Luke's Magic Valley Regional Medical Center, LTD.

  dba St Lukes Magic Valley - Air Ambulance

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1184144305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 312",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015823",
            "telephone_number": "208-814-8500",
            "fax_number": "208-814-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLEY",
        "first_name": "JACLYN",
        "middle_name": "JOHNSON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "JOLLEY",
            "middle_name": "JOHNSON",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Robert Max Johnson Jr., D.C.
• Samantha Wynn Johnson, NP
• Sara L Johnson, MD
• Sarah Johnson, AUD
• Allison Johnston, DPT
• Jolliff Counseling & Behavioral Health
• Jolliff Counseling & Behavioral Health
• Jolliff Counseling & Behavioral Health
• Jolliff Counseling & Behavioral Health, Inc
• Rachel Jolovich, LPC

• Physician Assistant in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.