IDAHO SPORTS MEDICINE INSTITUTE PA
NPI 1154356624
Neuromusculoskeletal Medicine, Sports Medicine in Boise, ID

Q: What is Idaho Sports Medicine Institute PA's NPI number?

The NPI number for Idaho Sports Medicine Institute PA is 1154356624. It was assigned to this organization in the NPPES registry on July 12, 2006.

Q: What is Idaho Sports Medicine Institute PA's specialty?

The primary specialty registered for this NPI is Neuromusculoskeletal Medicine, Sports Medicine with taxonomy code 204C00000X.

Active since July 12, 2006CLIA 13D2106073 · Microscopy

1188 UNIVERSITY DR, BOISE, ID 83706(208) 336-8250(208) 345-9514 Get Directions Write a Review

NPPES record last updated: January 6, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Idaho Sports Medicine Institute Pa NPPES

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

IDAHO SPORTS MEDICINE INSTITUTE PA (NPI 1154356624) is a healthcare organization registered as a neuromusculoskeletal medicine, sports medicine in Boise, Idaho and active in the NPI registry since July 2006. The organization holds a CLIA Microscopy certificate valid through October 6, 2027 and lists Jennifer R. Millier, Owner/partner, as its authorized official.

NPPES Registry Identity

NPI1154356624

Entity TypeOrganization

Primary Taxonomy204C00000X

Legal Business NameIDAHO SPORTS MEDICINE INSTITUTE PA

Location Address1188 UNIVERSITY DRBoise, ID 83706-3009

Mailing Address1188 W University DrBoise, ID 83706-3009 · (208) 336-8250 · Fax (208) 345-9514

Phone(208) 336-8250

Fax(208) 345-9514

Organization SubpartNo

Authorized OfficialJennifer R. MillierOwner/partner · (208) 336-8250

Enumeration DateJuly 12, 2006

Last NPPES UpdateJanuary 6, 2026

NPPES CertifiedJanuary 6, 2026

✔ NPI 1154356624 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNeuromusculoskeletal Medicine, Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code204C00000X

License✔ Licensed · N/A FOR GROUP

Definition

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/

1188 UNIVERSITY DR, Boise, ID 83706

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Other Identifiers 3

Medicaid805993900ID

OtherREGENCE BLUE SHIELDID · Group # 29145

Other8628-0ID · Blue Cross Of Idaho Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 13D2106073

Idaho Sports Medicine Institute · Boise, ID

Active · expires Oct 6, 2027

CLIA Number13D2106073

Laboratory TypePhysician Office

Certificate Effective DateOctober 7, 2025

Certificate Expiration DateOctober 6, 2027

Laboratory DirectorJaclyn M. Cooperrider

Laboratory Phone(208) 336-8250

Laboratory LocationIdaho Sports Medicine Institute1188 W University Dr, Boise, ID 83706

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 7

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

DR. KIRK J LEWIS MD

Orthopaedic Surgery (Sports Medicine)