NPIMap

Individual provider Active NPI

Jackie J Whitesell, MD

  • Neurology Physician
  • Boise, ID
National Provider Identifier
1346367984
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
M-11022 Issued in ID
Practice address
1072 N Liberty St
Suite 303
Boise, ID 83704-2800
Phone
(208) 367-2800
Fax
(208) 367-7111
NPI assigned
Mar 26, 2007
Last updated
Apr 23, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X M-11022 ID Primary

Addresses

Primary practice location

1072 N Liberty St
Suite 303
Boise, ID 83704-2800

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170

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
I20100714000994 ID Practitioner - Neurology 4587718176 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Indiana University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1072 N Liberty St
Boise, ID 83704-8708

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-11022IDMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Neurology Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jul 26, 2010 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Neurology CurrentSince Jul 26, 2010 Accepting new patients
Saint Alphonsus Specialty Services Inc Neurology PastSince Aug 1, 2016 Accepting new patients
Department of Neurology School of Medicine University of Utah Neurology Past Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

1072 N Liberty St
Ste 303
Boise, ID 83704
Phone (208) 302-4200

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

Interoperability endpoints

  • Direct secure messaging: jwhitesell1563294@direct.trinity-health.org

Organizations & group practices 5

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398211200000",
    "number": "1346367984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 N LIBERTY ST",
            "address_2": "SUITE 303",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837042800",
            "telephone_number": "208-367-2800",
            "fax_number": "208-367-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITESELL",
        "first_name": "JACKIE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2014-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ID",
            "license": "M-11022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.