NPIMap

Individual provider Active NPI

Jack Arthur Helgeson, RPH

  • Pharmacist
  • Payette, ID
National Provider Identifier
1972890366
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
P5317 Issued in ID
Practice address
405 S Main St
Payette, ID 83661-3317
Phone
(208) 642-9331
Fax
(208) 642-1550
NPI assigned
Jul 6, 2011
Last updated
Jul 6, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X P5317 ID Primary
Pharmacist 183500000X PH00009915 WA
Pharmacist 183500000X RPH0008024 OR

Addresses

Primary practice location

405 S Main St
Payette, ID 83661-3317

Mailing address

405 S 8TH St
Payette, ID 83661
Phone (208) 642-9331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
P5317IDMDPharmacist
RPH0008024ORMDPharmacist
PH00009915WAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309910400000",
    "number": "1972890366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 S 8TH ST",
            "city": "PAYETTE",
            "state": "ID",
            "postal_code": "83661",
            "telephone_number": "208-642-9331",
            "fax_number": "208-642-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S MAIN ST",
            "city": "PAYETTE",
            "state": "ID",
            "postal_code": "836613317",
            "telephone_number": "208-642-9331",
            "fax_number": "208-642-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELGESON",
        "first_name": "JACK",
        "middle_name": "ARTHUR",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-06",
        "last_updated": "2011-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P5317",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00009915",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH0008024",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Payette, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.