Individual provider Active NPI

Jared Ryan Ostermiller, LCSW

  • Clinical Social Worker
  • Rexburg, ID
National Provider Identifier
1760505747
Registry record updated Aug 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-1351 Issued in ID
Practice address
242 E 7TH N
Ste 4
Rexburg, ID 83440-3550
Phone
(208) 359-9683
Fax
(208) 359-0889
NPI assigned
Apr 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-1351 ID Primary

Addresses

Primary practice location

242 E 7TH N
Ste 4
Rexburg, ID 83440-3550

Mailing address

242 E 7TH N
Ste 4
Rexburg, ID 83440-3550
Phone (208) 359-9683

Other identifiers 4

IdentifierTypeStateIssuer
806530400MedicaidID
806867300MedicaidID
000010146334OtherIDBLUE SHIELD
L3688OtherIDBLUE CROSS

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190523002700 ID Practitioner - Clinical Social Worker 1557604006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ostermiller Counseling Services, Inc.Group PAC ID 3476896911, 5 clinicians

Practice addresses (Care Compare)

242 E 7TH
Suite 4
Rexburg, ID 83440-3550
Phone (208) 359-9683

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-1351IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ostermiller Counseling Services, Inc. Past Accepting new patients
Ostermiller Counseling Services Inc. Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535068800000",
    "number": "1760505747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 E 7TH N",
            "address_2": "STE 4",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834403550",
            "telephone_number": "208-359-9683",
            "fax_number": "208-359-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 E 7TH N",
            "address_2": "STE 4",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834403550",
            "telephone_number": "208-359-9683",
            "fax_number": "208-359-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSTERMILLER",
        "first_name": "JARED",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2018-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-1351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806530400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806867300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010146334",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "L3688",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.