Individual provider Active NPI

William F Jensen, MBA, ICADC

  • Addiction (Substance Use Disorder) Counselor
  • Burley, ID
National Provider Identifier
1477721637
Registry record updated Feb 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
1006393 Issued in ID
Practice address
2975 Overland Ave
Burley, ID 83318-3231
Phone
(208) 878-2600
Fax
(208) 878-1336
NPI assigned
Feb 11, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1006393 ID Primary

Addresses

Primary practice location

2975 Overland Ave
Burley, ID 83318-3231

Mailing address

2975 Overland Ave
Burley, ID 83318-3231
Phone (208) 878-2600

Other identifiers 1

IdentifierTypeStateIssuer
000010028636OtherIDREGENCE BLUE SHIELD

Other names 1

  • Mr. Bill F Jensen Other name

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
Credentials
Master of Business Administration

State licenses

LicenseStateTypeSpecialty
1006393IDMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1477721637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 OVERLAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833183231",
            "telephone_number": "208-878-2600",
            "fax_number": "208-878-1336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 OVERLAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833183231",
            "telephone_number": "208-878-2600",
            "fax_number": "208-878-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "WILLIAM",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "MBA, ICADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-11",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ID",
            "license": "1006393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010028636",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BILL",
            "last_name": "JENSEN",
            "middle_name": "F",
            "prefix": "MR.",
            "credential": "MBA, ICADC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.