Active NPI
Elizabeth Hart Sugden, MD
- Family Medicine Physician
- Jerome, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M5431
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 820227163G013 | Other | ID | TRICARE |
| 000010001456 | Other | ID | BLUE SHIELD OF IDAHO |
| 080064467 | Other | ID | MEDICARE RAILROAD |
| 820227163B002 | Other | ID | TRICARE |
| 1120618 | Other | ID | STATE INSURANCE FUND |
| 54312 | Other | ID | BLUE CROSS OF IDAHO |
| 000010142921 | Other | ID | BLUE SHIELD OF IDAHO |
| 003943200 | Medicaid | ID | |
| 820227163B002 | Other | ID | TRI CARE |
| J8499 | Other | ID | BLUE 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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| M5431 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke's Clinic LLC | Family Medicine | Current | 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.
-
dba St Lukes Clinic - Magic Valley/Jerome
- Family Medicine Physician
- Twin Falls, ID
- NPI 1790718229
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
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
- St Benedicts FMC Physician Assistants
- St Luke's Magic Valley Regional Medical Center LTD (St Luke's Jerome)
- St Lukes Magic Valley Regional Medical Center LTD (St Lukes Jerome Swing Beds)
- St. Benedicts Family Medical Center
- Malorie Stoker
- Lysha A Sullivan
- Summit Therapy Services
- Steve Scott Szabo
- Tdcjerome PLLC (Today's Dental Care)
- The Health Ranch, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; 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.