NPIMap

Organization Active NPI

Prime Sports Med

  • Chiropractor
  • Nampa, ID
National Provider Identifier
1407354574
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1618 Issued in ID
Legal business name
PRIME SPORTS MED
Practice address
1601 12TH Ave Rd
Suite 101
Nampa, ID 83686-5015
Phone
(208) 466-0200
NPI assigned
Jan 24, 2018
Last updated
May 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Dr. Jacob Bower, DCNPI 1891153391
Title
Chiropractor
Phone
(208) 466-0200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CHIA-1618 ID Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

1601 12TH Ave Rd
Suite 101
Nampa, ID 83686-5015

Mailing address

1601 12TH Ave Rd
Suite 101
Nampa, ID 83686-5015

Other practice location 1

701 Arthur St
Caldwell, ID 83605-3723
Phone (208) 999-6233

Other practice location 2

304 12th Ave Rd
Nampa, ID 83686-5015
Phone (208) 466-0200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210428001461 ID Part B Supplier - Clinic/Group Practice 9638587801 Receives reassigned benefits from 4 practitioners
Practice locations: Meridian, ID; Nampa, ID

National Provider Directory

National Provider Directory

Locations

701 Arthur St
Caldwell, ID 83605
Phone (208) 999-6233

3223 E Louise Dr
Ste 110
Meridian, ID 83642
Phone (208) 466-0200

1601 12th Ave Rd
Ste 101
Nampa, ID 83686
Phone (208) 466-0200

304 12th Ave Rd
Nampa, ID 83686
Phone (208) 466-0200

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1407354574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 12TH AVE RD",
            "address_2": "SUITE 101",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 12TH AVE RD",
            "address_2": "SUITE 101",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865015",
            "telephone_number": "208-466-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Arthur St",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836053723",
            "country_code": "US",
            "telephone_number": "208-999-6233",
            "fax_number": "208-463-0649",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "304 12th Ave Rd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836865015",
            "country_code": "US",
            "telephone_number": "208-466-0200",
            "fax_number": "208-463-0649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIME SPORTS MED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "BOWER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "208-466-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1618",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.