NPIMap

Individual provider Active NPI

Jody A. Stark, NP

  • Family Nurse Practitioner
  • Ontario, OR
National Provider Identifier
1851472989
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
079043254N1 Issued in OR
Practice address
932 W Idaho Ave
Suite 100
Ontario, OR 97914-2155
Phone
(541) 889-2244
Fax
(541) 889-2626
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 200550081NP OR
Family Nurse Practitioner 363LF0000X 079043254N1 OR Primary

Addresses

Primary practice location

932 W Idaho Ave
Suite 100
Ontario, OR 97914-2155

Mailing address

PO Box J
Ontario, OR 97914-0020
Phone (541) 889-2244

Other identifiers 2

IdentifierTypeStateIssuer
500656154MedicaidOR
500614019MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040206000952 OR Practitioner - Nurse Practitioner 0244123743 Reassigns benefits to 1 organization
I20071224000046 ID Practitioner - Nurse Practitioner 0244123743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stark Medical Group PCGroup PAC ID 4284873886, 3 clinicians

Practice addresses (Care Compare)

932 W Idaho Ave
Suite 100
Ontario, OR 97914-2155
Phone (541) 889-2244

Hospital & facility affiliations

  • Horizon Home Health West Home health agency, Caldwell, ID, CCN 137135
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052
  • West Valley Medical Center Hospital, Caldwell, ID, CCN 130014

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
079043254N1ORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stark Medical Group PC Family CurrentSince Jul 1, 2013 Accepting new patients
Emmett Counseling and Psychiatric Services, LLC CurrentSince Jan 1, 2011 Accepting new patients
Emmett Counseling and Psychiatric Services, LLC CurrentSince Jan 1, 2011 Accepting new patients
Stark Medical, PC Family Past Accepting new patients

Locations

2007 E Quail Run Rd
#1
Emmett, ID 83617
Phone (208) 365-5445

932 W Idaho Ave
Ontario, OR 97914
Phone (503) 889-2244

932 W Idaho Ave
Ste 100
Ontario, OR 97914
Phone (208) 381-9026

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1851472989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX J",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979140020",
            "telephone_number": "541-889-2244",
            "fax_number": "541-889-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "932 W IDAHO AVE",
            "address_2": "SUITE 100",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142155",
            "telephone_number": "541-889-2244",
            "fax_number": "541-889-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "JODY",
        "middle_name": "A.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200550081NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "079043254N1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500656154",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500614019",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, OR

Sources for this page

Verify at the official NPI Registry.