Jacob Sup, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

O-1402 Issued in ID

Practice address

2005 Arlington Ave
Caldwell, ID 83605-4808

Phone

(208) 459-1025

Fax

(208) 459-1080

NPI assigned

Mar 21, 2017

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Clinics IncGroup PAC ID 4082527353, 75 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Valley Medical Center Hospital, Caldwell, ID, CCN 130014
• St Luke's Nampa Medical Center Hospital, Nampa, ID, CCN 130071

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsup337683@direct.ochin.org

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.

• Community Health Clinics, Inc.

  dba Terry Reilly Health Services

  • Federally Qualified Health Center (FQHC)
  • Nampa, ID
  • NPI 1457309122

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Community Health Clinics, Inc.

  dba Terry Reilly - Vista

  • Federally Qualified Health Center (FQHC)
  • Boise, ID
  • NPI 1346254026
  NPD
• Community Health Clinics, Inc.

  dba Terry Reilly Health Services

  • Federally Qualified Health Center (FQHC)
  • Homedale, ID
  • NPI 1386757235

  Family Medicine

  NPD
• Community Health Clinics, Inc.

  dba Terry Reilly Health Services

  • Federally Qualified Health Center (FQHC)
  • Meridian, ID
  • NPI 1215941083

  Family Medicine

  NPD (past)
• Community Health Clinics, Inc.

  dba Terry Reilly Health Services

  • Federally Qualified Health Center (FQHC)
  • Nampa, ID
  • NPI 1689688459
  NPD (past)

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

• St Lukes West LTD

  dba St Lukes Nampa Medical Center

  • General Acute Care Hospital
  • Nampa, ID
  • NPI 1831590660
  Care Compare affiliation
• West Valley Medical Center Inc

  • General Acute Care Hospital
  • Middleton, ID
  • NPI 1609818483
  Care Compare affiliation
• West Valley Medical Center, Inc.

  dba West Valley Medical Center

  • General Acute Care Hospital
  • Caldwell, ID
  • NPI 1891732905
  Care Compare affiliation

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1295266401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-467-4431",
            "fax_number": "208-466-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 ARLINGTON AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054808",
            "telephone_number": "208-459-1025",
            "fax_number": "208-459-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUP",
        "first_name": "JACOB",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-1402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret H Strowd, M.ED
• Stephanie Cherie Stuck, LCPC
• Kaysea Lee Studioso-Hatch, DO
• Deborah Lee Sullivan, ARNP
• Samuel M Summers, MD
• Surgical Group, P.a.
• Brendon James Swenson, D.D.S., M.S.
• Holly Taft, LCSW
• John Christopher Taggart Jr., LPC
• Gloria Tague, LSW

• Family Medicine Physician in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.