Jessica Maddox, M.D.
Individual provider Active NPI Pediatrics Physician · Driggs, ID
NPI 1801281175 · NPPES record last updated Mar 31, 2026
Key facts
- NPI
- 1801281175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- M-14388 (ID)
- Practice address
- 30 N 1St St
Driggs, ID 83422-5219 - Phone
- (204) 435-8846
- Fax
- (208) 918-8628
- NPI assigned
- Apr 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211209000993 | ID | Practitioner - Pediatric Medicine | 3870866239 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Pediatrics | Current |
Accepting new patients |
| Teton River Pediatrics | Pediatrics | Current | 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
30 N 1st St
Driggs, ID 83422
Phone (204) 435-8846
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M-14388 | ID | Yes |
Addresses
Primary practice location
30 N 1St St
Driggs, ID 83422-5219
Mailing address
PO Box 760
Driggs, ID 83422-0760
Phone (208) 435-8846
Other providers in Driggs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.