NPIMap

Individual provider Active NPI

Jodie D Callison, DMD

  • General Practice Dentistry
  • Marsing, ID
National Provider Identifier
1508480575
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-5146 Issued in ID
Practice address
201 Main
Marsing, ID 83639
Phone
(208) 896-4159
Fax
(208) 466-5359
NPI assigned
Jun 4, 2020
Last updated
Jun 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D-5146 ID Primary

Addresses

Primary practice location

201 Main
Marsing, ID 83639

Mailing address

PO Box 9
Nampa, ID 83653-0009
Phone (208) 461-7149

Other names 1

  • Jo D Callison Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200720000206 ID Order and Referring Only - DentistPractitioner - Dentist 7416371844

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D-5146IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jcallison337634@direct.ochin.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1508480575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-461-7149",
            "fax_number": "208-466-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MAIN",
            "city": "MARSING",
            "state": "ID",
            "postal_code": "83639",
            "telephone_number": "208-896-4159",
            "fax_number": "208-466-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLISON",
        "first_name": "JODIE",
        "middle_name": "D",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-04",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-5146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JO",
            "last_name": "CALLISON",
            "middle_name": "D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marsing, ID

Sources for this page

Verify at the official NPI Registry.