Individual provider Active NPI

Jeffrey Ha

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1750077012
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1071299 Issued in ID
Practice address
510 N 2ND St Ste 103
Boise, ID 83702-6081
Phone
(208) 381-4700
Fax
(208) 381-4977
NPI assigned
Apr 11, 2023
Last updated
Jan 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1071299 ID Primary

Addresses

Primary practice location

510 N 2ND St Ste 103
Boise, ID 83702-6081

Mailing address

190 E Bannock St
Boise, ID 83712-6241

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
I20260113002530 ID Practitioner - Physician Assistant 8628554250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

3101 E State St
Eagle, ID 83616-6232

510 N 2ND St
Suite 103
Boise, ID 83702-6081
Phone (208) 381-4700

520 S Eagle Rd
Meridian, ID 83642-6351

520 S Eagle Rd
Meridian, ID 83642-6352

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1071299IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jan 5, 2026 Accepting new patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Jan 5, 2026 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

510 N 2nd St
Ste 103
Boise, ID 83702
Phone (208) 381-4700

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767571200000",
    "number": "1750077012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N 2ND ST STE 103",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026081",
            "telephone_number": "208-381-4700",
            "fax_number": "208-381-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HA",
        "first_name": "JEFFREY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-11",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "1071299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.