Jacqlyn Raivo, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D1101 Issued in ID

Practice address

1859 S Topaz Way Ste 100
Meridian, ID 83642-4401

Phone

(208) 209-2432

Fax

(847) 859-5885

NPI assigned

Feb 18, 2019

Sex

Female

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

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rocky Mountain Diabetes and Osteoporosis Center PAGroup PAC ID 5890750483, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FEFDAA
• Direct secure messaging: jacqlyn.raivo.1@33233.direct.athenahealth.com

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.

• Rocky Mountain Diabetes and Osteoporosis Center PA

  • Endocrinology, Diabetes & Metabolism Physician
  • Idaho Falls, ID
  • NPI 1336220243
  Medicare reassignment Care Compare group NPD
• RM Lab LLC

  • Clinical Medical Laboratory
  • Idaho Falls, ID
  • NPI 1659301349
  NPD

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

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1740746403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY STE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611454",
            "telephone_number": "847-737-8768",
            "fax_number": "847-859-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1859 S TOPAZ WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424401",
            "telephone_number": "208-209-2432",
            "fax_number": "847-859-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAIVO",
        "first_name": "JACQLYN",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-18",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D1101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Douglas Racine, PT, DPT
• Paige Rackham
• Jacob Radil, PA-C
• Cyndy Eldredge Radovich, MMA
• Hala Gamal Rafla, MPAS
• Susan L Ralph, NP
• Gina Ramirez
• William Clayton Ramos, DC
• Jeremy Rampton, MS
• Jessica L Ramsey, L.C.P.C.

• Registered Dietitian in Meridian, ID
• Providers in Meridian, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.