NPIMap

Individual provider Active NPI

Deo M Peppersack, NP

  • Family Nurse Practitioner
  • Nampa, ID
National Provider Identifier
1770538811
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP656A Issued in ID
Practice address
217 W Georgia Ave Ste 120
Nampa, ID 83686-6812
Phone
(208) 498-1760
Fax
(208) 498-1761
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X NP656A ID
Family Nurse Practitioner 363LF0000X NP656A ID Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP656A ID

Addresses

Primary practice location

217 W Georgia Ave Ste 120
Nampa, ID 83686-6812

Mailing address

217 W. Georgia Ave. Ste 120
Nampa, ID 83686-2856
Phone (208) 498-1760

Other identifiers 3

IdentifierTypeStateIssuer
8083269MedicaidID
806976700MedicaidID
NP191OtherIDBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041021000818 ID Practitioner - Nurse Practitioner 1850352915 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Psychiatry and Family WellnessGroup PAC ID 4486189925, 2 clinicians

Practice addresses (Care Compare)

217 W Georgia Ave
Suite 120
Nampa, ID 83686-6812
Phone (208) 498-1760

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP656AIDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Psychiatry and Family Wellness CurrentSince Jan 1, 2025 Accepting new patients
5 Peppers Inc Past Accepting new patients
5 Pepper Inc Dba Acacia Wellness Center Past Accepting new patients

Locations

217 W Georgia Ave
Ste 120
Nampa, ID 83686
Phone (208) 498-1760

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458259200000",
    "number": "1770538811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 W. GEORGIA AVE. STE 120",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836862856",
            "telephone_number": "208-498-1760",
            "fax_number": "208-498-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 W GEORGIA AVE STE 120",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866812",
            "telephone_number": "208-498-1760",
            "fax_number": "208-498-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPPERSACK",
        "first_name": "DEO",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "NP656A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP656A",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "NP656A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8083269",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806976700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "NP191",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.