NPIMap

Organization Active NPI

Jason Champagne Idaho 4, PLLC

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1508614033
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
JASON CHAMPAGNE IDAHO 4, PLLC
Practice address
345 W Bobwhite CT
Boise, ID 83706-3982
Phone
(208) 345-1383
NPI assigned
May 9, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Jason Champagne, DDS
Title
Owner
Phone
(775) 359-3934

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

345 W Bobwhite CT
Boise, ID 83706-3982

Mailing address

PO Box 2070
Sparks, NV 89432-2070

Other names 1

  • Blue Heron Dental Doing business as

National Provider Directory

National Provider Directory

Locations

345 W Bobwhite Ct
Boise, ID 83706
Phone (208) 345-1383

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1508614033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2070",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894322070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 W BOBWHITE CT",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063982",
            "telephone_number": "208-345-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON CHAMPAGNE IDAHO 4, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "CHAMPAGNE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-359-3934",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Heron Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.

Verify at the official NPI Registry.