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PRIME SPORTS MED
NPI 1407354574
Chiropractor in Nampa, ID

Active since January 24, 2018
1601 12TH AVE RD, SUITE 101, NAMPA, ID 83686(208) 466-0200 Get Directions Write a Review

NPPES record last updated: May 25, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 25, 2021, Jul 9, 2020 (2 updates tracked since 2020).

About Prime Sports Med NPPES

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

PRIME SPORTS MED (NPI 1407354574) is a healthcare organization registered as a chiropractor in Nampa, Idaho and active in the NPI registry since January 2018. The organization maintains 2 additional practice locations and lists Jacob Bower, Chiropractor, as its authorized official.

NPPES Registry Identity

NPI1407354574
Entity TypeOrganization
Primary Taxonomy111N00000X
Legal Business NamePRIME SPORTS MED
Location Address1601 12TH AVE RD, SUITE 101Nampa, ID 83686-5015
Mailing Address1601 12th Ave Rd, Suite 101Nampa, ID 83686-5015
Phone(208) 466-0200
Organization SubpartNo
Authorized OfficialJacob BowerChiropractor · (208) 466-0200
Enumeration DateJanuary 24, 2018
Last NPPES UpdateMay 25, 20212 updates tracked since enumeration
NPPES CertifiedMay 25, 2021
✔ NPI 1407354574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License✔ Licensed in ID · CHIA-1618
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Also ListedPhysical TherapistTaxonomy 225100000X
1601 12TH AVE RD, Nampa, ID 83686
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Secondary Practice Locations 2

Location 1701 Arthur StCaldwell, ID 83605-3723 · Phone (208) 999-6233 · Fax (208) 463-0649
Location 2304 12th Ave RdNampa, ID 83686-5015 · Phone (208) 466-0200 · Fax (208) 463-0649

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Prime Sports Med is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Prime Sports Med, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Jacob Bower
Chiropractic
NPI 1891153391
1601 12TH AVE RD SUITE 101
Nampa, ID 83686
(208) 466-0200
✔ PECOS✔ Accepts MedicareSame address
Samuel Field, DC
Chiropractic
NPI 1023588019
1601 12TH AVE RD SUITE 101
Nampa, ID 83686
(208) 466-0200
✔ Accepts MedicareSame address
Jared Simonson, DPT
Physical Therapist in Private Practice
NPI 1194001297
1601 12TH AVE RD SUITE 101
Nampa, ID 83686
(208) 466-0200
✔ Accepts MedicareSame address
Marco Ruvalcaba, DC
Chiropractic
NPI 1245727593
3223 E LOUISE AVE SUITE 110
Meridian, ID 83642
(208) 466-0200
✔ Accepts Medicare12 mi

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

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prime Sports Med's NPI number?

The NPI number for Prime Sports Med is 1407354574. It was assigned to this organization in the NPPES registry on January 24, 2018.

Where is Prime Sports Med located?

Prime Sports Med is located at 1601 12th Ave Rd Suite 101, Nampa, ID 83686. The listed phone number is (208) 466-0200.

What is Prime Sports Med's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Prime Sports Med enrolled in Medicare?

Yes. Prime Sports Med is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Prime Sports Med?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Prime Sports Med. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Chiropractic (3) and Physical Therapist in Private Practice (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Prime Sports Med was last updated on May 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.