5 Peppers Inc.
Organization Active NPI Family Medicine Physician · Nampa, ID
NPI 1669612271 · NPPES record last updated Mar 9, 2016
Key facts
- NPI
- 1669612271
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- 5 PEPPERS INC.
- Practice address
- 217 W Georgia Ave Ste 120
Nampa, ID 83686-6812 - Phone
- (208) 498-1760
- Fax
- (208) 498-1769
- NPI assigned
- Feb 23, 2009
- Organization subpart
- No
Authorized official
- Name
- Mrs. Deo Marie Peppersack, FNP
- Title
- Owner
- Phone
- (208) 498-1760
Practitioners 5
-
Rebekah G Fayette, CNM, PMHNP
-
McKenzie Mary Morcom, CNP, PMHNP-BC
-
Jana Duncan, ANP
-
Deo M Peppersack, NP
-
Lauryn Pyke, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090325000692 | ID | Part B Supplier - Clinic/Group Practice | 7517024169 |
Receives reassigned benefits from 5 practitioners Practice locations: Nampa, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | LMSW-27706 | ID | |
| Family Medicine Physician |
207Q00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X | 656A | ID | |
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | NP656A | ID |
Addresses
Primary practice location
217 W Georgia Ave Ste 120
Nampa, ID 83686-6812
Mailing address
353 W Iowa Ave
Nampa, ID 83686-2856
Phone (208) 498-1760
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8083269 | Medicaid | ID | |
| 806976700 | Medicaid | ID |
Other names
- DBA Acacia Wellness Center
Other providers in Nampa, ID
- 1 A a Premier Home Care LLC
- 1918 Winter Street Operating Co LLC
- 2M0Tiv8, PLLC
- 5 Pepper Inc Dba Acacia Wellness Center
- 5 Peppers Inc
- A Blessing Home Care Inc
- A New Life Mental Health
- A Tender Heart Home Care, LLC
- A Way Through LLC
- A&R Case Management
All providers in Nampa, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.