NPIMap

Organization Active NPI

Idaho Clinic

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Boise, ID
National Provider Identifier
1225629074
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
Legal business name
IDAHO CLINIC
Practice address
8854 W Emerald St Ste 290
Boise, ID 83704-4846
Phone
(208) 287-9420
NPI assigned
Feb 3, 2021
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Jared Armstrong, MDNPI 1609040567
Title
Owner
Phone
(206) 300-8584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X NU Primary

Addresses

Primary practice location

8854 W Emerald St Ste 290
Boise, ID 83704-4846

Mailing address

1940 S Bonito Way Ste 190
Meridian, ID 83642-5618
Phone (208) 287-9420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210602000792 ID Part B Supplier - Clinic/Group Practice 5799184362 Receives reassigned benefits from 6 practitioners
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

8854 W Emerald St
Ste 290
Boise, ID 83704
Phone 2082879420123

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1225629074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S BONITO WAY STE 190",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425618",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 290",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044846",
            "telephone_number": "208-287-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-300-8584",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.