NPIMap

Organization Active NPI

Orthopaedic Trauma Consultants of Idaho

Doing business as North Fork Orthopedic Surgery

  • Orthopaedic Surgery Physician
  • Meridian, ID
National Provider Identifier
1336907450
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPAEDIC TRAUMA CONSULTANTS OF IDAHO
Doing business as
North Fork Orthopedic Surgery
Practice address
875 S Vanguard Way Ste 110
Meridian, ID 83642-8541
Phone
(208) 595-4440
Fax
(855) 592-2514
NPI assigned
Mar 12, 2024
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Jesse Dylan Chlebeck, MDNPI 1073879185
Title
Owner
Phone
(208) 595-4440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

875 S Vanguard Way Ste 110
Meridian, ID 83642-8541

Mailing address

875 S Vanguard Way Ste 110
Meridian, ID 83642-8541
Phone (208) 595-4440

Other names 1

  • North Fork Orthopedic Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240520001764 ID Part B Supplier - Clinic/Group Practice 8527400720 Receives reassigned benefits from 2 practitioners
Practice locations: Meridian, ID
O20251103003625 ID DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8527400720 Practice locations: Meridian, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1336907450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 S VANGUARD WAY STE 110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428541",
            "telephone_number": "208-595-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S VANGUARD WAY STE 110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428541",
            "telephone_number": "208-595-4440",
            "fax_number": "855-592-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDIC TRAUMA CONSULTANTS OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "CHLEBECK",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "DYLAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-595-4440",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Fork Orthopedic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.