NPIMap

Individual provider Active NPI

Robert Elvon Jackson, MD

  • Urology Physician
  • Meridian, ID
National Provider Identifier
1184740045
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
M-11868 Issued in ID
Practice address
875 S Vanguard Way
Suite 200 D
Meridian, ID 83642
Phone
(208) 782-6730
Fax
(208) 759-7822
NPI assigned
Mar 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301087650 MI
Urology Physician 208800000X 4301087650 MI
Urology Physician 208800000X M-11868 ID Primary

Addresses

Primary practice location

875 S Vanguard Way
Suite 200 D
Meridian, ID 83642

Mailing address

875 S Vanguard Way
Suite 200 D
Meridian, ID 83642
Phone (208) 782-6730

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
I20130305000587 ID Practitioner - Urology 9830347533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Iowa, RJ & L Carver College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Urology ClinicGroup PAC ID 8325587652, 3 clinicians

Practice addresses (Care Compare)

875 S Vanguard Way
Suite 200D
Meridian, ID 83642-8540
Phone (208) 782-6730

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • Treasure Valley Hospital Hospital, Boise, ID, CCN 130063
  • St Luke'S Wood River Medical Center Hospital, Ketchum, ID, CCN 131323
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection33
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-11868IDMDUrology Physician
4301087650MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Urology CurrentSince Feb 1, 2013 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Feb 1, 2013 Accepting new patients
Urology Clinic Urology CurrentSince Sep 1, 2024 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

305 E Jefferson St
#102
Boise, ID 83712
Phone (208) 343-2820

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

1202 E Locust St
Emmett, ID 83617
Phone (208) 365-2338

875 S Vanguard Way
Ste 200D
Meridian, ID 83642
Phone (208) 782-6730

Interoperability endpoints

  • Direct secure messaging: rjackson17838@direct.slhs.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/AFJEDD/Endpoint/AFJEDD

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 and National Provider Directory roles.

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": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1184740045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 S VANGUARD WAY",
            "address_2": "SUITE 200 D",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-782-6730",
            "fax_number": "208-759-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S VANGUARD WAY",
            "address_2": "SUITE 200 D",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-782-6730",
            "fax_number": "208-759-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERT",
        "middle_name": "ELVON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301087650",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301087650",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "M-11868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.