Jeremy Shupperd, CPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

Practice address

427 N Curtis Rd
Boise, ID 83706-1439

Phone

(208) 342-4104

Fax

(208) 342-4106

NPI assigned

Apr 4, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1306698071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061439",
            "telephone_number": "208-342-4104",
            "fax_number": "208-342-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061439",
            "telephone_number": "208-342-4104",
            "fax_number": "208-342-4106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "504 N 10th Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836052925",
            "country_code": "US",
            "telephone_number": "208-453-6404",
            "fax_number": "208-453-6402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "542 Addison Ave W",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015039",
            "country_code": "US",
            "telephone_number": "208-342-4104",
            "fax_number": "208-736-7332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUPPERD",
        "first_name": "JEREMY",
        "name_prefix": "Mr.",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetist in Boise, ID
• Providers in Boise, ID by specialty
• Prosthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.