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REVOLUTIONARY MEDICINE OF IDAHO
NPI 1487493292
Nurse Practitioner - Family in Boise, ID

Active since May 21, 2024CLIA 13D2305651 · Waiver
4776 N FIVE MILE RD STE 101, BOISE, ID 83713(986) 777-0278(208) 658-9501 Get Directions Write a Review

NPPES record last updated: May 21, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Revolutionary Medicine Of Idaho NPPES

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

REVOLUTIONARY MEDICINE OF IDAHO (NPI 1487493292) is a healthcare organization registered as a family in Boise, Idaho and active in the NPI registry since May 2024. The organization holds a CLIA Waiver certificate valid through June 3, 2028 and lists Jeffrey D Robbins, Owner, as its authorized official.

NPPES Registry Identity

NPI1487493292
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameREVOLUTIONARY MEDICINE OF IDAHO
Location Address4776 N FIVE MILE RD STE 101Boise, ID 83713-2715
Mailing Address2536 Canyon Rd SMelba, ID 83641-5258 · (208) 871-0297
Phone(986) 777-0278
Fax(208) 658-9501
Organization SubpartNo
Authorized OfficialJeffrey D RobbinsOwner · (208) 871-0297
Enumeration DateMay 21, 2024
NPPES CertifiedMay 21, 2024
✔ NPI 1487493292 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
4776 N FIVE MILE RD STE 101, Boise, ID 83713
Open in Google Maps ↗

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 Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Revolutionary Medicine Of Idaho is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Revolutionary Medicine Of Idaho, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jeffrey Robbins, FNP
Nurse Practitioner
NPI 1669408514
4776 N FIVE MILE RD STE 101
Boise, ID 83713
(208) 986-7770
✔ PECOS✔ Accepts MedicareSame address

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

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 of Waiver 13D2305651

Revolutionary Medicine Of Idaho · Boise, ID
Active · expires Jun 3, 2028
CLIA Number13D2305651
Laboratory TypePractitioner Other
Certificate Effective DateJune 4, 2026
Certificate Expiration DateJune 3, 2028
Laboratory DirectorJeffrey D. Robbins
Laboratory Phone(986) 777-0278
Laboratory LocationRevolutionary Medicine Of Idaho4776 N Five Mile Rd Ste 101, Boise, ID 83713
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Revolutionary Medicine Of Idaho's NPI number?

The NPI number for Revolutionary Medicine Of Idaho is 1487493292. It was assigned to this organization in the NPPES registry on May 21, 2024.

Where is Revolutionary Medicine Of Idaho located?

Revolutionary Medicine Of Idaho is located at 4776 N Five Mile Rd Ste 101, Boise, ID 83713. The listed phone number is (986) 777-0278.

What is Revolutionary Medicine Of Idaho's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Revolutionary Medicine Of Idaho enrolled in Medicare?

Yes. Revolutionary Medicine Of Idaho is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Revolutionary Medicine Of Idaho?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Revolutionary Medicine Of Idaho. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Revolutionary Medicine Of Idaho hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2305651) is associated with this NPI, valid through June 3, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Revolutionary Medicine Of Idaho accept?

Health plans from Molina Healthcare list Revolutionary Medicine Of Idaho as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Revolutionary Medicine Of Idaho was last updated on May 21, 2024. 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.