NPIMap

Organization Active NPI

Vision Quest Medical Center, PA

  • Ophthalmology Physician
  • Meridian, ID
National Provider Identifier
1568664506
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
O-0860 Issued in ID
Legal business name
VISION QUEST MEDICAL CENTER, PA
Practice address
3025 W Cherry LN
Suite 207
Meridian, ID 83642-1125
Phone
(208) 898-1614
Fax
(208) 898-1618
NPI assigned
Jun 1, 2007
Last updated
Oct 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Jacob Adam Mong, DONPI 1346535481
Title
President
Phone
(208) 377-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-100002 ID
Optometrist 152W00000X ODP-100417 ID
Ophthalmology Physician 207W00000X O-0860 ID Primary

Addresses

Primary practice location

3025 W Cherry LN
Suite 207
Meridian, ID 83642-1125

Mailing address

5680 W Gage St
Boise, ID 83706-1326
Phone (208) 377-3937

Other practice location 1

2720 W Cherry Ln
Meridian, ID 83642-1137
Phone (208) 377-3937

Other identifiers 6

IdentifierTypeStateIssuer
001553800MedicaidID
46235OtherIDBLUE CROSS GROUP NO
806834700MedicaidID
807072300MedicaidID
000160500MedicaidID
807072200MedicaidID

Other names 1

  • Sonntag Eye Associates Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171220000841 ID Part B Supplier - Clinic/Group Practice 0547528598 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID; Caldwell, ID; Meridian, ID

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Sonntag Eye Associates3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

5680 W Gage St
Boise, ID 83706
Phone (208) 377-3937

2720 W Cherry Ln
Meridian, ID 83642
Phone (208) 377-3937

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1568664506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 W GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061326",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 W CHERRY LN",
            "address_2": "SUITE 207",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421125",
            "telephone_number": "208-898-1614",
            "fax_number": "208-898-1618"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2720 W Cherry Ln",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836421137",
            "country_code": "US",
            "telephone_number": "208-377-3937",
            "fax_number": "208-377-9455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VISION QUEST MEDICAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "MONG",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-377-3937",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100002",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100417",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "O-0860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001553800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NO",
            "identifier": "46235",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806834700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807072300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000160500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807072200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonntag Eye Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sonntag Eye Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.