Jed Burke Willardson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-779 Issued in ID

Practice address

2377 Coronado St
Suite C
Idaho Falls, ID 83404-7440

Phone

(208) 523-7246

Fax

(208) 523-7247

NPI assigned

Oct 28, 2008

Last updated

Mar 4, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment Care Compare group NPD
• Mountain View Hospital Physician Organization

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1073834529
  NPD (past)

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

• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236124800000",
    "number": "1578716072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2404",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834032404",
            "telephone_number": "208-523-7246",
            "fax_number": "208-523-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2377 CORONADO ST",
            "address_2": "SUITE C",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047440",
            "telephone_number": "208-523-7246",
            "fax_number": "208-523-7247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARDSON",
        "first_name": "JED",
        "middle_name": "BURKE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-28",
        "last_updated": "2009-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jesse Wille
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• Whitney Williams Dutton, LPC

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.