Jill Moughamian, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

NP-1708A Issued in ID

Practice address

4700 N Cloverdale Rd Ste 103
Boise, ID 83713-1067

Phone

(208) 392-8383

NPI assigned

Apr 1, 2016

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

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmoughamian20018@direct.slhs.org

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  Medicare reassignment NPD
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)
• Cornerstone Pediatrics, P.C.

  dba Cornerstone Pediatrics

  • Primary Care Clinic/Center
  • Prescott Valley, AZ
  • NPI 1679851455
  NPD (past)

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459468800000",
    "number": "1760845259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 E TARPON DR STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429007",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N CLOVERDALE RD STE 103",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131067",
            "telephone_number": "208-392-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUGHAMIAN",
        "first_name": "JILL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-01",
        "last_updated": "2016-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ID",
            "license": "NP-1708A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "NP-1708A",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Lee Moss, P.T.
• Motion Chiropractic PLLC
• Carla Motley
• Ali Astrid Moto, LMSW
• Freddy Moto
• Lakshmi Mouli
• Mountain Creek Medical, LLC, Jennifer Rice Sole MBR (Mountain Creek Medical, LLC)
• Mountain State Breast & General Surgery PLLC
• Mountain States Counseling & Psychological Services PLLL
• Mountain States Group, Inc

• Pediatric Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Pediatric Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.