Individual provider Active NPI

Jill Suhy Stiller, ARNP-CNP

  • Family Nurse Practitioner
  • Sandpoint, ID
National Provider Identifier
1700334737
Registry record updated Sep 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
54178 Issued in ID
Practice address
1215 Michigan St
Ste B
Sandpoint, ID 83864-5014
Phone
(208) 265-2418
Fax
(208) 263-0583
NPI assigned
Sep 19, 2016
Last updated
Sep 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 54178 ID Primary

Addresses

Primary practice location

1215 Michigan St
Ste B
Sandpoint, ID 83864-5014

Mailing address

902 Shepherds LN
Sandpoint, ID 83864-9707
Phone (208) 920-0285

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170104000423 ID Practitioner - Nurse Practitioner 2365723459 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
54178IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Michael R Dibenedetto MD PLLC CurrentSince Nov 27, 2016 Accepting new patients
Sandpoint Drug Inc PastSince Sep 1, 2022 Accepting new patients

Locations

30544 Highway 200
Ste 102
Ponderay, ID 83852
Phone (208) 265-9817

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537142400000",
    "number": "1700334737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 SHEPHERDS LN",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838649707",
            "telephone_number": "208-920-0285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 MICHIGAN ST",
            "address_2": "STE B",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645014",
            "telephone_number": "208-265-2418",
            "fax_number": "208-263-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLER",
        "first_name": "JILL",
        "middle_name": "SUHY",
        "credential": "ARNP-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2018-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "54178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandpoint, ID

Sources for this page

Verify at the official NPI Registry.