NPIMap

Individual provider Active NPI

Jared S Johnson, MD

  • Orthopaedic Surgery Physician
  • Boise, ID
National Provider Identifier
1891982559
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
M-12474 Issued in ID
Practice address
8854 W Emerald St Ste 102
Boise, ID 83704-4845
Phone
(208) 323-4747
Fax
(208) 323-4848
NPI assigned
Sep 26, 2007
Last updated
Feb 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A107698 CA
Orthopaedic Surgery Physician 207X00000X M-12474 ID Primary

Addresses

Primary practice location

8854 W Emerald St Ste 102
Boise, ID 83704-4845

Mailing address

1940 S Bonito Way Ste 190
Meridian, ID 83642-5618
Phone (208) 287-9420

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
I20140916000448 ID Practitioner - Orthopedic Surgery 8729125125 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
JS Weill Medical College, Cornell University, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Shoulder Clinic of Idaho PLLCGroup PAC ID 5698860021, 5 clinicians

Practice addresses (Care Compare)

8854 W Emerald St
Suite 102
Boise, ID 83704-4845
Phone (208) 323-4747

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
107698CAMDDentist
M-12474IDMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Shoulder Clinic of Idaho PLLC Orthopaedic Surgery CurrentSince May 30, 2020 Accepting new patients
Ortho Urgent Care Medical Group, Inc. Past Accepting new patients

Locations

8854 W Emerald St
Ste 102
Boise, ID 83704
Phone (208) 323-4747

1940 S Bonito Way
Ste 190
Meridian, ID 83642

Interoperability endpoints

  • Direct secure messaging: jared.johnson@2698.securemail.prognocis.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Treasure Valley HospitalBoise, ID, CCN 130063 Hospital Limited Partnership Interest (1.08%) Oct 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1891982559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S BONITO WAY STE 190",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425618",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST STE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044845",
            "telephone_number": "208-323-4747",
            "fax_number": "208-323-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JARED",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-26",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A107698",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "M-12474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.