Jacob Adam Mong, D.O.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

O-0860 Issued in ID

Practice address

5680 W Gage St
Boise, ID 83706-1326

Phone

(208) 377-3937

Fax

(208) 377-9455

NPI assigned

Jun 16, 2011

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Ophthalmology

Education

Michigan State University College of Osteopathic Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vision Quest Medical Center PAGroup PAC ID 0547528598, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.92 of 100Reported as group

Quality

100

Improvement activities

40

Cost

76.41

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Vision Quest Medical Center, PA

  • Ophthalmology Physician
  • Boise, ID
  • NPI 1356542542

  OR

  Medicare reassignment Care Compare group
• Maple Grove Eyecare PC

  • Ophthalmology Physician
  • Boise, ID
  • NPI 1124684485
  Medicare reassignment NPD
• J C Pitts Enterprises Inc

  • Ambulatory Surgical Clinic/Center
  • Ontario, OR
  • NPI 1730252487
  NPD Authorized official
• Vision Quest Medical Center, PA

  • Ophthalmology Physician
  • Caldwell, ID
  • NPI 1497234306
  NPD (past) Authorized official
• Premier Surgical Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Boise, ID
  • NPI 1275516718
  NPD

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1346535481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 East Ln S",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "OR",
            "postal_code": "979143058",
            "country_code": "US",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-4559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3025 W Cherry Ln Ste 207",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836428530",
            "country_code": "US",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONG",
        "first_name": "JACOB",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-16",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "1346535481",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "O-0860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346535481",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "20006959",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Rose Monarres
• Carson Nicole Mondada, PA-C
• Frederick Dominic Mondin, EDD
• Gregory W. Mondin, PH.D.
• Perla Mondragon
• Donna Marie Puninani Moniz
• Kathryn Patricia Monnig, LCPC
• Anjannette Monroe, LCSW
• Crystal Monroe, LMT
• Fiona Zhen Bao Montagne

• Ophthalmology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Ophthalmology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.