NPIMap

Individual provider Active NPI

Justin McCoy, DO

  • Sports Medicine (Family Medicine) Physician
  • Boise, ID
National Provider Identifier
1265792238
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
DR.0057008 Issued in CO
Practice address
777 N Raymond St
Boise, ID 83704-9251
Phone
(208) 514-2500
Fax
(208) 375-2217
NPI assigned
May 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-0857 ID
Sports Medicine (Family Medicine) Physician 207QS0010X DR.0057008 CO Primary

Addresses

Primary practice location

777 N Raymond St
Boise, ID 83704-9251

Mailing address

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Other identifiers 1

IdentifierTypeStateIssuer
1265792238MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160728000361 CO Practitioner - Family PracticePractitioner - Sports Medicine 6103142120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intermountain Medical Group Grand Junction, LLCGroup PAC ID 3779707856, 297 clinicians

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

627 25
Grand Junction, CO 81505-6401
Phone (970) 242-3535

Hospital & facility affiliations

  • Intermountain Health St. Mary'S Regional Hospital Hospital, Grand Junction, CO, CCN 060023
  • Family Health West Hospital Hospital, Fruita, CO, CCN 061302
  • Montrose Regional Health Hospital, Montrose, CO, CCN 060006
  • Community Hospital Hospital, Grand Junction, CO, CCN 060054
  • Delta County Memorial Hospital Hospital, Delta, CO, CCN 060071

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-0857IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Grand Junction, LLC Family Medicine CurrentSince Sep 1, 2018 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Sep 1, 2018 Accepting new patients
St Mary'S Hospital and Medical Center, Inc Family Medicine Past Accepting new patients

Locations

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

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.

Hospital & facility affiliations 8

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": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1265792238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-23",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0857",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CO",
            "license": "DR.0057008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265792238",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.