Individual provider Active NPI

Elizabeth Hart Sugden, MD

  • Family Medicine Physician
  • Jerome, ID
National Provider Identifier
1356485767
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M5431 Issued in ID
Practice address
132 5TH Ave W
Jerome, ID 83338-1825
Phone
(208) 324-5286
Fax
(208) 324-9815
NPI assigned
Feb 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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 M5431 ID Primary

Addresses

Primary practice location

132 5TH Ave W
Jerome, ID 83338-1825

Mailing address

PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400

Other identifiers 10

IdentifierTypeStateIssuer
820227163G013OtherIDTRICARE
000010001456OtherIDBLUE SHIELD OF IDAHO
080064467OtherIDMEDICARE RAILROAD
820227163B002OtherIDTRICARE
1120618OtherIDSTATE INSURANCE FUND
54312OtherIDBLUE CROSS OF IDAHO
000010142921OtherIDBLUE SHIELD OF IDAHO
003943200MedicaidID
820227163B002OtherIDTRI CARE
J8499OtherIDBLUE CROSS OF IDAHO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050706001097 ID Practitioner - Family Practice 4284670795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

775 Pole Line Rd W
Twin Falls, ID 83301-5814
Phone (208) 814-1500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M5431IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Clinic LLC Family Medicine CurrentSince Apr 7, 2012 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

709 N Lincoln Ave
Jerome, ID 83338
Phone (208) 324-4301

132 5th Ave W
Ste 1
Jerome, ID 83338
Phone (208) 814-9800

132 5th Ave W
Jerome, ID 83338
Phone (207) 324-4992

132 5th Ave W
Ste 2
Jerome, ID 83338
Phone (208) 324-5286

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

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.

NPI Registry JSON

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

{
    "created_epoch": "1171756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1356485767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 5TH AVE W",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833381825",
            "telephone_number": "208-324-5286",
            "fax_number": "208-324-9815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUGDEN",
        "first_name": "ELIZABETH",
        "middle_name": "HART",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-18",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M5431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "820227163G013",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010001456",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080064467",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "820227163B002",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE INSURANCE FUND",
            "identifier": "1120618",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "54312",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010142921",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003943200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI CARE",
            "identifier": "820227163B002",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "J8499",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jerome, ID

Sources for this page

Verify at the official NPI Registry.