IDAHO SPORTS MEDICINE INSTITUTE PA
NPI 1154356624
Neuromusculoskeletal Medicine, Sports Medicine in Boise, ID
- Organization
- Neuromusculoskeletal Medicine, Sports Me...
- Accepts Insurance
- CLIA Number: 13D2106073
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 10-06-2027
About IDAHO SPORTS MEDICINE INSTITUTE PA
This page provides the complete NPI Profile along with additional information for Idaho Sports Medicine Institute Pa, a provider established in Boise, Idaho operating as a Neuromusculoskeletal Medicine, Sports Medicine. The healthcare provider is registered in the NPI registry with number 1154356624 assigned on July 2006. The practitioner's primary taxonomy code is 204C00000X with license number N/A FOR GROUP (). The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Jennifer R. Millier M.d. (Owner/partner)
- NPI
- 1154356624 Verify this NPI
- Provider Name
- IDAHO SPORTS MEDICINE INSTITUTE PA
- Entity Type
- Organization
- Location Address
- 1188 UNIVERSITY DR BOISE, ID 83706
- Location Phone
- (208) 336-8250
- Location Fax
- (208) 345-9514
- Mailing Address
- 1188 W UNIVERSITY DR BOISE, ID 83706
- Mailing Phone
- (208) 336-8250
- Mailing Fax
- (208) 345-9514
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-12-2006
- Last Update Date
- 01-06-2026
- Code Navigator
Location Map
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
Neuromusculoskeletal Medicine, Sports Medicine
- Taxonomy Code
- 204C00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- N/A FOR GROUP
- Taxonomy Description
- A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation. Source: American Osteopathic Association Additional Resources: AOA Osteopathic Board Certification in Neuromusculoskeletal Medicine; https://certification.osteopathic.org/sports-medicine/
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 805993900 | MEDICAID (05) | ID | |
| REGENCE BLUE SHIELD | OTHER (01) | ID | GROUP # 29145 |
| 8628-0 | OTHER (01) | ID | BLUE CROSS OF IDAHO GROUP |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D2106073
- Facility Type
- Physician Office
- Certificate Effective Date
- October 07, 2025
- Certificate Expiration Date
- October 06, 2027
- Laboratory Director
- JACLYN M. COOPERRIDER
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Idaho Sports Medicine Institute Pa in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Other Providers at the Same Location
The following 7 providers are registered at the same or a nearby location.
BOISE, ID 83706
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154356624, enumerated as an "organization" on July 12, 2006.
The provider is located at 1188 UNIVERSITY DR BOISE, ID 83706 and the phone number is (208) 336-8250.
Neuromusculoskeletal Medicine, Sports Medicine with taxonomy code 204C00000X.
The provider might be accepting Accepts: Moda Health Plan, Inc., Medicare, Medicaid and. Please consult your insurance carrier or call the provider to verify.
