Jay Phan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3561779 Issued in ID

Practice address

419 Shoup Ave W
Twin Falls, ID 83301-5028

Phone

(209) 996-1700

NPI assigned

Sep 25, 2024

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mental Wellness and Relationship Services LLCGroup PAC ID 5092106443, 8 clinicians

Associates in Family Practice IncGroup PAC ID 2163330325, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Associates in Family Practice Inc

  • Family Medicine Physician
  • Gooding, ID
  • NPI 1326002650

  ID

  Medicare reassignment Care Compare group NPD
• Mental Wellness and Relationship Services LLC

  • Marriage & Family Therapist
  • Coeur D Alene, ID
  • NPI 1932773363

  ID

  Medicare reassignment Care Compare group NPD
• Associates in Family Practice Inc

  • Family Medicine Physician
  • Gooding, ID
  • NPI 1023030848
  Care Compare group
• Associates in Family Practice Inc

  • Family Medicine Physician
  • Gooding, ID
  • NPI 1881659357
  NPD

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

{
    "created_epoch": "1727222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1669299152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 LYNWOOD BLVD",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 SHOUP AVE W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015028",
            "telephone_number": "209-996-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JAY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "3561779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Trevor Petersen, PHARMD
• Winston N Petersen, PA-C
• Kirk C Peterson, MD
• Kylan D Peterson, D.O.
• Nathan Michael Peterson, DDS
• Seth Phillips, PT
• Sue V. Phillips, D.C.
• Huberta L Phipps, LCPC
• Physician Center , a Professional Company
• Physician Center a Professional Company Mid Level

• All providers in Twin Falls, ID
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.