NPIMap

Individual provider Active NPI

Jason Forgeon, MD

  • Emergency Medicine Physician
  • Burley, ID
National Provider Identifier
1952961732
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
M-17330 Issued in ID
Practice address
1501 Hiland Ave
Burley, ID 83318-2688
Phone
(208) 678-4444
NPI assigned
Jun 14, 2019
Last updated
Jul 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MT218930 PA
Emergency Medicine Physician 207P00000X 13034934-1205 UT
Emergency Medicine Physician 207P00000X M-17330 ID Primary

Addresses

Primary practice location

1501 Hiland Ave
Burley, ID 83318-2688

Mailing address

PO Box 30180
Salt Lake City, UT 84130-0180

Other practice location 1

2545 Schoenersville Rd
Bethlehem, PA 18017-7300
Phone (484) 884-2888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, UT2 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
I20230810000214 ID Practitioner - Emergency Medicine 7214262518 Reassigns benefits to 1 organization
I20231211002779 UT Practitioner - Emergency Medicine 7214262518 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Valley Medical CenterGroup PAC ID 2668380460, 25 clinicians

Practice addresses (Care Compare)

48 W 1500
Nephi, UT 84648-8900
Phone (435) 623-3200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Ihc Health Services Inc CurrentSince Jul 1, 2023 Accepting new patients
Lehigh Valley Physician Group Emergency Medicine Current Accepting new patients
West Emergency Services, LLC Emergency Medicine CurrentSince Jul 1, 2024 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Central Valley Medical Center Current Accepting new patients

Locations

1501 Hiland Ave
Burley, ID 83318
Phone (208) 678-4444

1501 Hiland Ave
Ste K
Burley, ID 83318
Phone (208) 678-1126

1200 S Cedar Crest Blvd
Allentown, PA 18103
Phone (484) 862-3200

48 W 1500 N
Nephi, UT 84648
Phone (435) 623-3000

300 N Hospital Dr
Price, UT 84501
Phone (435) 636-4836

Organizations & group practices 7

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 2

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": "1560470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1952961732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30180",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 HILAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182688",
            "telephone_number": "208-678-4444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2545 Schoenersville Rd",
            "address_purpose": "LOCATION",
            "city": "Bethlehem",
            "state": "PA",
            "postal_code": "180177300",
            "country_code": "US",
            "telephone_number": "484-884-2888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORGEON",
        "first_name": "JASON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-14",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MT218930",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "13034934-1205",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-17330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

Verify at the official NPI Registry.