Active NPI
Jason Sharp
- Psychologist
- Pocatello, ID
National Provider Identifier
1447084058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- SE-203873
- Practice address
- 500 S 11TH Ave Ste 204
Pocatello, ID 83201-4878 - Phone
- (208) 232-7862
- NPI assigned
- Aug 27, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | SE-203873 | ID | Primary |
Addresses
Primary practice location
500 S 11TH Ave Ste 204
Pocatello, ID 83201-4878
Mailing address
500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880
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 |
|---|---|---|---|
| SE-203873 | ID | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1447084058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 S 11TH AVE STE 400",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S 11TH AVE STE 204",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014878",
"telephone_number": "208-232-7862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHARP",
"first_name": "JASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-27",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ID",
"license": "SE-203873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.