NPIMap

Individual provider Active NPI

Joseph W Ippolito Jr., M.D.

  • Family Medicine Physician
  • Twin Falls, ID
National Provider Identifier
1306862792
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M7008 Issued in ID
Practice address
526 Shoup Ave W
Suite F
Twin Falls, ID 83301-6050
Phone
(208) 736-7620
Fax
(208) 735-9537
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M7008 ID Primary

Addresses

Primary practice location

526 Shoup Ave W
Suite F
Twin Falls, ID 83301-6050

Mailing address

526 Shoup Ave W
Suite F
Twin Falls, ID 83301-5050
Phone (208) 736-7620

Other identifiers 3

IdentifierTypeStateIssuer
000010001696OtherIDREGENCE BLUE SHIELD OF ID
DY066OtherIDBLUE CROSS OF IDAHO
003755600MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL PSM

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
I20060807000323 ID Practitioner - Family Practice 1557364809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

526 Shoup Ave W
Suite F
Twin Falls, ID 83301-5050
Phone (208) 736-7620

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.52 of 100Reported as individual
Quality
98.82
Improvement activities
40
Cost
79.99

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M7008IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph W Ippolito Jr MD PLLC Family Medicine CurrentSince Nov 23, 2001 Accepting new patients

Locations

206 Martin St
#B
Twin Falls, ID 83301
Phone (208) 733-2022

526 Shoup Ave W
Ste F
Twin Falls, ID 83301
Phone (208) 734-3457

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDCECA
  • FHIR API: https://fhir4.healow.com/fhir/r4/DDCECA/Endpoint/DDCECA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Visions Home Health LLCTwin Falls, ID, CCN 137107 Home health agency Corporate Director Sep 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

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": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1306862792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W",
            "address_2": "SUITE F",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-736-7620",
            "fax_number": "208-735-9537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W",
            "address_2": "SUITE F",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016050",
            "telephone_number": "208-736-7620",
            "fax_number": "208-735-9537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IPPOLITO",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010001696",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "DY066",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003755600",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "PSM",
            "affiliation": "N",
            "address_1": "526 Shoup Ave W",
            "address_2": "Suite F",
            "city": "Twin Falls",
            "state": "ID",
            "country_code": "US",
            "postal_code": "833016050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.