JACOB SUP DO
NPI 1295266401
Family Medicine in Caldwell, ID

Q: What is Jacob Sup's NPI number?

The NPI number for Jacob Sup is 1295266401. It was assigned to this individual provider in the NPPES registry on March 21, 2017.

Q: What is Jacob Sup's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Sup was last updated on August 7, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 21, 2017PECOS EnrolledAccepts Medicare Assignment

2005 ARLINGTON AVE, CALDWELL, ID 83605(208) 459-1025(208) 459-1080 Get Directions Write a Review

NPPES record last updated: August 7, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 7, 2020, Mar 21, 2017 (2 updates tracked since 2017).

On this page

About Jacob Sup Do NPPES

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

JACOB SUP DO (NPI 1295266401) is an individual family medicine provider in Caldwell, Idaho, licensed in Idaho (O-1402) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS, is affiliated with West Valley Medical Center, and is a graduate of At Still Un Of Hlth Sciences, Col Of Osteo Med, Mesa (2017).

NPPES Registry Identity

NPI1295266401

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameJACOB SUPCredential: DO

Location Address2005 ARLINGTON AVECaldwell, ID 83605-4808

Mailing AddressPo Box 9Nampa, ID 83653-0009 · (208) 467-4431 · Fax (208) 466-5359

Phone(208) 459-1025

Fax(208) 459-1080

Sole ProprietorNo

Medical School CMSAt Still Un Of Hlth Sciences, Col Of Osteo Med, MesaGraduated 2017

Enumeration DateMarch 21, 2017

Last NPPES UpdateAugust 7, 20202 updates tracked since enumeration

NPPES CertifiedAugust 7, 2020

✔ NPI 1295266401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in ID · O-1402

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2005 ARLINGTON AVE, Caldwell, ID 83605

Open in Google Maps ↗

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacob Sup Do 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 ID749609055

PECOS Enrollment IDI20201005002920

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.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

27 services19 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

West Valley Medical Center

Acute Care Hospitals · Caldwell, ID

5/5 CMS rating

OwnershipProprietary

CMS Certification Number130014

Location1717 Arlington StreetCaldwell, ID 83605 · Canyon County

Emergency services

St Luke's Nampa Medical Center

Acute Care Hospitals · Nampa, ID

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number130071

Location9850 West St Lukes DriveNampa, ID 83687 · Canyon County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83605 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.13 typical visit price

range $52.44 – $160.17

Typical copayment $20.28 (range $13.11 – $40.04)

Most-billed visit code 99203

Established Patient

$93.26 typical visit price

range $16.68 – $130.93

Typical copayment $23.31 (range $4.17 – $32.73)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260

DME-Hospital Beds · category DB000N

1 supplier12 claims12 services$36.85 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Leave this field empty

Other Providers at the Same Location NPPES 13

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

COMMUNITY HEALTH CLINICS, INC.

Clinic/Center (Federally Qualified Health Center (FQHC))