NPIMap

Individual provider Active NPI

Jared Henderson, MD

  • Family Medicine Physician
  • Twin Falls, ID
National Provider Identifier
1336597152
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-13901 Issued in ID
Practice address
512 Pole Line Rd Ste 2
Twin Falls, ID 83301-6367
Phone
(208) 735-3636
Fax
(208) 735-3637
NPI assigned
Jun 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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 M-13901 ID Primary

Addresses

Primary practice location

512 Pole Line Rd Ste 2
Twin Falls, ID 83301-6367

Mailing address

512 Pole Line Rd Ste 2
Twin Falls, ID 83301-6367
Phone (208) 740-4866

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
I20190618001797 ID Practitioner - Family Practice 0648563403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Innovative Family Medicine of Idaho PLLCGroup PAC ID 2668820556, 9 clinicians

Practice addresses (Care Compare)

512 Pole Line Rd
Suite 2
Twin Falls, ID 83301-6367
Phone (208) 254-0047

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions30

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Family Medicine of Idaho PLLC Family Medicine CurrentSince Jan 17, 2024 Accepting new patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

512 Pole Line Rd
#2
Twin Falls, ID 83301
Phone (208) 254-0047

526 Shoup Ave W
Twin Falls, ID 83301
Phone (208) 733-2400

1411 Falls Ave E
Ste 1301
Twin Falls, ID 83301
Phone (208) 732-0067

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEJBDD
  • Direct secure messaging: jhenderson79440@direct.slhs.org

Organizations & group practices 2

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": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1336597152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 POLE LINE RD STE 2",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016367",
            "telephone_number": "208-740-4866",
            "fax_number": "208-375-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 POLE LINE RD STE 2",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016367",
            "telephone_number": "208-735-3636",
            "fax_number": "208-735-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JARED",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-02",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-13901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.