NPIMap

Individual provider Active NPI

Avery Jeffers, MD

  • Internal Medicine Physician
  • Preston, ID
National Provider Identifier
1386083764
Registry record updated Jul 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M-13287 Issued in ID
Practice address
44 N. 1St E.
Attn: Colleen Jensen
Preston, ID 83263-1326
Phone
(208) 852-3662
Fax
(208) 852-1295
NPI assigned
Jun 19, 2013
Last updated
Jul 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M-13287 ID Primary

Addresses

Primary practice location

44 N. 1St E.
Attn: Colleen Jensen
Preston, ID 83263-1326

Mailing address

44 N 1St E
Preston, ID 83263-1326
Phone (208) 852-3662

Other practice location 1

47 N. 1st E.
Attn: Colleen Jensen
Preston, ID 83263-1326
Phone (208) 852-2900

Other identifiers 2

IdentifierTypeStateIssuer
1386083764MedicaidID
M-13287OtherIDMEDICAL LICENSE

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
I20160727000629 ID Practitioner - Internal Medicine 3173816246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Colorado School of Medicine, Denver, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franklin County Medical CenterGroup PAC ID 8820909104, 25 clinicians

Practice addresses (Care Compare)

44 N 1St
Preston, ID 83263-1326
Phone (208) 852-0137

64 N 1St
Suite 200
Preston, ID 83263-1326
Phone (208) 852-3662

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-13287IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franklin County Medical Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: avery.jeffers.1@17373.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Franklin County Transitional CarePreston, ID, CCN 135059 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (5%)
Adp of the SNF
Indirect Ownership Interest		 May 24, 2022
Apr 1, 2026
May 24, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Franklin County Medical Center

    dba Franklin County Medical Center Transitional Care Unit

    • Skilled Nursing Facility
    • Preston, ID
    • NPI 1093056475

    5% Or Greater Indirect Ownership Interest, Adp of the SNF, Indirect Ownership Interest

    CMS ownership
  • Franklin County Medical Center

    dba FCMC Specialty Clinic

    • Critical Access Hospital
    • Preston, ID
    • NPI 1548355811

    5% Or Greater Indirect Ownership Interest, Adp of the SNF, Indirect Ownership Interest

    CMS ownership

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1386083764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 N 1ST E",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631326",
            "telephone_number": "208-852-3662",
            "fax_number": "208-852-1295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 N. 1ST E.",
            "address_2": "ATTN: COLLEEN JENSEN",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631326",
            "telephone_number": "208-852-3662",
            "fax_number": "208-852-1295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "47 N. 1st E.",
            "address_2": "Attn: Colleen Jensen",
            "address_purpose": "LOCATION",
            "city": "Preston",
            "state": "ID",
            "postal_code": "832631326",
            "country_code": "US",
            "telephone_number": "208-852-2900",
            "fax_number": "208-852-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERS",
        "first_name": "AVERY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-19",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M-13287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386083764",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "M-13287",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Preston, ID

Sources for this page

Verify at the official NPI Registry.