NPIMap

Individual provider Active NPI

Jason Southwick, PH.D.

  • Clinical Neuropsychologist
  • Boise, ID
National Provider Identifier
1538412382
Registry record updated May 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY - 202728 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-2121
NPI assigned
Oct 17, 2012
Last updated
May 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY - 202728 ID Primary
Clinical Psychologist 103TC0700X PSY - 202728 ID

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (082) 367-2121

Other practice location 1

3597 E Monarch Sky Ln Ste 240
Meridian, ID 83646-1055
Phone (208) 391-7274

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
I20131113001499 ID Practitioner - Clinical Psychologist 7315173747 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY - 202728IDMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Meridian Neuropsychology PLLC Clinical Neuropsychologist CurrentSince Oct 10, 2014 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Clinical Neuropsychologist CurrentSince Oct 1, 2023 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 1, 2023 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3061 S Meridian Rd
Ste 100
Meridian, ID 83642
Phone (208) 620-5399

3597 E Monarch Sky Ln
Ste 240
Meridian, ID 83646
Phone (208) 996-3519

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715990400000",
    "number": "1538412382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "082-367-2121",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3597 E Monarch Sky Ln Ste 240",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836461055",
            "country_code": "US",
            "telephone_number": "208-391-7274",
            "fax_number": "208-629-1231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHWICK",
        "first_name": "JASON",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-17",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "ID",
            "license": "PSY - 202728",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY - 202728",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.