Active NPI
Jean Marc Cardinal, MD
- Diagnostic Radiology Physician
- Blackfoot, ID
National Provider Identifier
1356423073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- M5908
- Practice address
- 98 Poplar St
Blackfoot, ID 83221-1758 - Phone
- (208) 785-3810
- NPI assigned
- Oct 20, 2006
- Last updated
- Mar 15, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | M5908 | ID | Primary |
Addresses
Primary practice location
98 Poplar St
Blackfoot, ID 83221-1758
Mailing address
PO Box 2896
Idaho Falls, ID 83403-2896
Phone (208) 552-8762
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356423073 | Medicaid | ID | |
| P00010238 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5908 | ID | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1356423073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2896",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834032896",
"telephone_number": "208-552-8762",
"fax_number": "208-523-2025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98 POPLAR ST",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832211758",
"telephone_number": "208-785-3810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARDINAL",
"first_name": "JEAN",
"middle_name": "MARC",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-20",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "ID",
"license": "M5908",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356423073",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00010238",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Blackfoot, ID
- Camp Hippo Pediatric Therapy LLC
- Camp Hippo Pediatric Therapy LLC.
- Chelsee Ann Campbell
- Amador Ramirez Cantu, D.O.
- Angelo Michael Capricchione, MD
- Katrina Haley Carl, ATC, LAT
- Darcey Lynn Carr, COTA
- Brian Carrigan, MD
- Childrens Supportive Services Incorporated
- Childrens Supportive Services Incorporated
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.