Keaton Jake Suitter, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-9695 Issued in ID

Practice address

502 S Woodruff Ave
Idaho Falls, ID 83401-5298

Phone

(208) 346-7500

NPI assigned

Aug 8, 2023

Last updated

Aug 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

4 Pillars of Success LLCGroup PAC ID 4688027188, 19 clinicians

Pearl Health ClinicGroup PAC ID 0840356077, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• 4 Pillars of Success LLC

  dba Rehabilitative Health Services

  • Multi-Specialty Clinic/Center
  • Ammon, ID
  • NPI 1619134277
  Medicare reassignment Care Compare group NPD
• Pearl Health Clinic

  • Mental Health Counselor
  • Ammon, ID
  • NPI 1447426465
  Medicare reassignment Care Compare group NPD
• 4 Pillars of Success LLC

  dba Rehabilitative Health Services

  • Clinic/Center
  • Ammon, ID
  • NPI 1992487615
  NPD

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1639852668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015298",
            "telephone_number": "208-346-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015298",
            "telephone_number": "208-346-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUITTER",
        "first_name": "KEATON",
        "middle_name": "JAKE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC-9695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alessandra Stubblefield
• Shana L Stubblefield, LMSW
• Christina Stubbs
• Renae Michelle Suarez, LMSW
• Emily Sucher, RDN
• Rebecca T Sulik
• Sullivan Mental Health Services LLC
• Jessie Elaine Sullivan, LCPC,LMFT
• Joshua Summers, DO
• Patti Joleen Summers, LPC

• Mental Health Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.