Active NPI
Jade Stevens
- Massage Therapist
- Sandpoint, ID
National Provider Identifier
1417504507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS3788
- Practice address
- 515 Pine St Ste G
Sandpoint, ID 83864-1658 - Phone
- (208) 575-8309
- NPI assigned
- Aug 22, 2019
- Last updated
- Aug 22, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MAS3788 | ID | Primary |
Addresses
Primary practice location
515 Pine St Ste G
Sandpoint, ID 83864-1658
Mailing address
515 Pine St Ste G
Sandpoint, ID 83864-1658
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MAS3877 | Other | ID | LICENSED MASSAGE THERAPIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MAS3788 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566432000000",
"number": "1417504507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 PINE ST STE G",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 PINE ST STE G",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641658",
"telephone_number": "208-575-8309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENS",
"first_name": "JADE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-22",
"last_updated": "2019-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS3788",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED MASSAGE THERAPIST",
"identifier": "MAS3877",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.