MR. JACOB WAYNE MOSS (NPI# 1205179751) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205179751 |
| Entity Type | Individual |
| Full Name | MR. JACOB WAYNE MOSS |
| Credential | M.D., J.D. |
| Practice Address |
1995 E 17th St Idaho Falls ID 83404-6493 |
| Mailing Address |
236 Harvard Ave Rexburg ID 83440-2211 |
| Practice Telephone | 2085381999 |
| Practice Fax Number | 2088815295 |
| Mailing Telephone | 2083131438 |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-02-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | M-14547 | ID | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 30 Madison Professional Park, Rexburg, ID 834402058 | 2085381999 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053621912 | Jacob Russell Moss | Social Worker | 12636 Se Stark St, Plaza 125, Bldg J, Portland, OR 97233-1058 | 2010-10-13 |
| Street Address |
1995 E 17TH ST |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-6493 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295738797 | Eric A Wingerson | Internal Medicine | 1995 E 17th St, St. #4, Idaho Falls, ID 83404-6493 | 2005-05-27 |
| 1609492347 | Jason T Rinker | Physician Assistant | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2020-06-18 |
| 1942836911 | Amerihealth Inc | Psychologist | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2020-03-20 |
| 1730652280 | Brandy Lee Larson | Nurse Practitioner | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2019-01-08 |
| 1104320324 | Daniel Joseph Barney | Nurse Practitioner | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2018-03-21 |
| 1962919662 | Derek Richard Whitmill | Nurse Practitioner | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2018-01-03 |
| 1134647019 | Randall James Law | Physician Assistant | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2017-08-31 |
| 1417498890 | Kara Dee Boll | Nurse Practitioner | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2017-03-17 |
| 1932526373 | Mountain Falls Medical LLC | Nurse Practitioner | 1995 E 17th St, Idaho Falls, ID 83404-6493 | 2014-03-24 |
| 1376852053 | Kirsten A Davis | Massage Therapist | 1995 E 17th St, Suite 2, Idaho Falls, ID 83404-6493 | 2010-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275696734 | William R Eder | General Practice | 740 S Woodruff Ave, Idaho Falls, ID 83401-5285 | 2006-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508467051 | Janene Caldwell Witherite | General Practice | 1077 Stellar End Rd, Victor, ID 83455-4973 | 2020-11-02 |
| 1336797042 | Brightview Senior Health | General Practice | 1983 N Synergy Pl, Eagle, ID 83616-7332 | 2019-08-27 |
| 1346801941 | Daniel Campbell | General Practice | 2939 E Idavada Ct, Nampa, ID 83686-5899 | 2019-06-25 |
| 1932581089 | Matthew Hall | General Practice | 1232 Rigby Rd, Bancroft, ID 83217 | 2015-06-25 |
| 1881074201 | Lindsey Wells | General Practice | 2537 W State St Ste 110, Boise, ID 83702-2200 | 2015-06-01 |
| 1043697576 | William Chapman | General Practice | 1948 W. Blackwell Mill Road, Coeur D Alene, ID 83814 | 2015-05-05 |
| 1265824312 | Drugshield Inc | General Practice | 3085 N Cole Rd, Ste 108, Boise, ID 83704-5968 | 2015-02-26 |
| 1215344353 | Lanie Benson | General Practice | 460 N 3rd E, Driggs, ID 83422-5146 | 2014-07-22 |
| 1356614770 | Charles Thomas Mcgee | General Practice | 2385 W Bolivar Ave, Coeur D Alene, ID 83815-9134 | 2012-02-15 |
| 1487926564 | Boise Image Enhancement Centre, Inc. | General Practice | 9382 W Overland Rd, Boise, ID 83709-2505 | 2012-02-03 |
| Find all providers with the same taxonomy | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.