JAXSON LAYNE STARK MS
NPI 1144559527
Counselor - Mental Health in Ammon, ID

Q: What is Jaxson Stark's NPI number?

The NPI number for Jaxson Stark is 1144559527. It was assigned to this individual provider in the NPPES registry on December 15, 2009.

Q: What is Jaxson Stark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Jaxson Stark was last updated on December 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 15, 2009PECOS EnrolledAccepts Medicare Assignment

2705 E 17TH ST, AMMON, ID 83406(208) 360-0067 Get Directions Write a Review

NPPES record last updated: December 6, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 6, 2023, Feb 21, 2017 (2 updates tracked since 2017).

On this page

About Jaxson Layne Stark Ms NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAXSON LAYNE STARK MS (NPI 1144559527) is an individual mental health provider in Ammon, Idaho, licensed in Idaho (LCPC 5501) and active in the NPI registry since December 2009. He is enrolled in Medicare PECOS and is a graduate of Other (2007).

NPPES Registry Identity

NPI1144559527

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameJAXSON LAYNE STARKCredential: MS

Location Address2705 E 17TH STAmmon, ID 83406-6601

Mailing Address3770 N Haderlie LnIona, ID 83427-7723 · (208) 360-0067

Phone(208) 360-0067

Sole ProprietorYes

Medical School CMSOtherGraduated 2007

Enumeration DateDecember 15, 2009

Last NPPES UpdateDecember 6, 20232 updates tracked since enumeration

NPPES CertifiedDecember 6, 2023

✔ NPI 1144559527 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in ID · LCPC 5501

2705 E 17TH ST, Ammon, ID 83406

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Molina Healthcare, PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jaxson Layne Stark Ms is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6204287162

PECOS Enrollment IDI20240104004885

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jaxson Stark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pearl Health Clinic

Same address

Mental Health

2705 E 17TH ST
Ammon, ID 83406

Reassigned Medicare billing, Idaho enrollment
45 clinicians in this Medicare group

NPI 1447426465 (208) 346-7500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUMMER MANGELSON

Social Worker