Individual provider Active NPI

Perry A. Jansen, M.D., MPH

  • Family Medicine Physician
  • Caldwell, ID
National Provider Identifier
1417230251
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-13453 Issued in ID
Practice address
13307 Miami LN
Caldwell, ID 83607-4701
Phone
(208) 455-5300
Fax
(208) 454-7722
NPI assigned
Sep 27, 2011
Last updated
Apr 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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 M-13453 ID Primary

Addresses

Primary practice location

13307 Miami LN
Caldwell, ID 83607-4701

Mailing address

13307 Miami LN
Caldwell, ID 83607-4701
Phone (208) 455-5300

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
I20230621002142 ID Practitioner - Family Practice 0345408647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Pennsylvania State University College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest District HealthGroup PAC ID 0143465666, 3 clinicians

Practice addresses (Care Compare)

13307 Miami LN
Caldwell, ID 83607-4701
Phone (208) 455-5300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-13453IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest District Health Family Medicine CurrentSince May 14, 2023 Accepting new patients

Locations

13307 Miami Ln
Caldwell, ID 83607
Phone (208) 455-5300

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20689/brand/1/csg/1/fhir/r4
  • Direct secure messaging: perry.jansen.1@20689.direct.athenahealth.com

Organizations & group practices 1

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": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1417230251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13307 MIAMI LN",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836074701",
            "telephone_number": "208-455-5300",
            "fax_number": "208-454-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13307 MIAMI LN",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836074701",
            "telephone_number": "208-455-5300",
            "fax_number": "208-454-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "PERRY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-27",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-13453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

Verify at the official NPI Registry.