Jennifer L Preucil, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M7812 Issued in ID

Practice address

2550 Addison Ave E
Suite B
Twin Falls, ID 83301-6749

Phone

(208) 814-7700

Fax

(208) 933-9301

NPI assigned

Jun 16, 2006

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 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Visions Home Health & Visions Home Care LLC Home health agency, Twin Falls, ID, CCN 137107
• St Lukes Home Care and Hospice Home health agency, Meridian, ID, CCN 137028
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
• St Luke'S Jerome Hospital, Jerome, ID, CCN 131310
• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpreucil39020@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 Luke'S Clinic LLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229
  Medicare reassignment Care Compare group NPD
• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Luke'S Magic Valley Regional Medical Center LTD

  • Critical Access Hospital
  • Jerome, ID
  • NPI 1366874877
  Care Compare affiliation
• St Luke'S Regional Medical Center

  • Home Health Agency
  • Meridian, ID
  • NPI 1306945985
  Care Compare affiliation
• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation
• St. Luke'S Magic Valley Regional Medical Center, LTD.

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation
• Visions Home Health & Visions Home Care, LLC

  • Home Health Agency
  • Twin Falls, ID
  • NPI 1235137761
  Care Compare affiliation

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419811200000",
    "number": "1922042209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 ADDISON AVE E",
            "address_2": "SUITE B",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016749",
            "telephone_number": "208-814-7700",
            "fax_number": "208-933-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREUCIL",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2014-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805473400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCRR",
            "identifier": "P00460913",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Life Wellness LLC
• Kent H Pressman, MD
• Amanda Jo Prestigiacomo, FNP-C
• Amy A Prestin, LCPC
• Daniel G Preucil, M.D.
• Janice Preuit
• Primary Therapy Source LLC
• Primary Therapy Source LLC
• Primary Therapy Source LLC
• Primary Therapy Source, Inc

• Family Medicine Physician in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.