JERRY DUANE LILLY ED.S
NPI 1124390786
Counselor - Professional in Eagle, ID
NPI Status: Active since January 29, 2012
Contact Information
172 S ACADEMY AVE STE 160
EAGLE, ID
ZIP 83616
Phone: (208) 315-4855
- Individual
- Male
- Counselor
- Professional
- Accepts Insurance
- Opted-Out Medicare
About JERRY LILLY
This page provides the complete NPI Profile along with additional information for Jerry Lilly, a provider established in Eagle, Idaho with a medical specialization in Counselor, focusing in professional . The healthcare provider is registered in the NPI registry with number 1124390786 assigned on January 2012. The practitioner's primary taxonomy code is 101YP2500X with license number LCPC-6990 (ID). The provider is registered as an individual and his NPI record was last updated one year ago.
- NPI
- 1124390786
- Provider Name
- JERRY DUANE LILLY ED.S
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 172 S ACADEMY AVE STE 160 EAGLE, ID 83616
- Location Phone
- (208) 315-4855
- Mailing Address
- 12073 N HUMPHREYS WAY BOISE, ID 83714
- Mailing Phone
- (208) 315-4855
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 01-29-2012
- Last Update Date
- 09-11-2025
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Jerry Lilly opted out of Medicare effective on 07-31-2024 until 07-31-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Secondary Locations
- 12073 N Humphreys Way
Boise, ID 83714
(208) 315-4855
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Counselor Professional
- Taxonomy Code
- 101YP2500X
- Type
- Behavioral Health & Social Service Providers
- License No.
- LCPC-6990
- License State
- ID
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
- Core Bronze HSA 10600 - EPO
- Core Bronze HSA 7500 - EPO
- Core Bronze HSA 8300 - EPO
- Core Gold 1500 - EPO
- Core Gold 3000 - EPO
- Core Silver 3500 - EPO
- Core Silver 4500 - EPO
- Core Silver 5000 - EPO
- Core Silver 7500 - EPO
- Core Standard Expanded Bronze HSA - EPO
- Core Standard Gold - EPO
- Core Standard Silver - EPO
- PacificSource Oregon Standard Bronze HSA Plan Core - EPO
- PacificSource Oregon Standard Gold Plan Core - EPO
- PacificSource Oregon Standard Silver Plan Core - EPO
- Med Benchmark Expanded Bronze Select Copay Plan - HMO
- Med Benchmark Expanded Bronze Standardized Plan - HMO
- Med Benchmark Gold Standardized Plan - HMO
- Med Benchmark Platinum - HMO
- Med Benchmark Platinum Standardized Plan - HMO
- Med Benchmark Silver 6000 Medical Deductible w/Vision - HMO
- Med Benchmark Silver Standardized Plan - HMO
- Med Gold 1500 Medical Deductible - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 07-31-2024
Opt-Out End Date: 07-31-2026
Eligible to Order and Refer? No
Reviews for JERRY DUANE LILLY ED.S
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1124390786, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 64 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
EAGLE, ID 83616
EAGLE, ID 83616
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124390786, enumerated as an "individual" on January 29, 2012.
The provider is located at 172 S ACADEMY AVE STE 160 EAGLE, ID 83616 and the phone number is (208) 315-4855.
Counselor with taxonomy code 101YP2500X and a focus in Professional.
The provider might be accepting Accepts: Moda Health Plan, Inc., PacificSource Health Plans. Please consult your insurance carrier or call the provider to verify.
