JACOB SUP (DO) – Family Medicine Physician, NPI 1295266401
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
971 FAMILY PRACTICE in ID
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Provider Addresses for JACOB SUP (DO)
Nampa, Canyon County, Idaho, United States
NAMPA, ID 836530009
Phone: (208) 467-4431
Fax: (208) 466-5359
Type: Mailing
2005, Arlington Avenue, Caldwell, Canyon County, Idaho, 83605, United States
CALDWELL, ID 836054808
Phone: (208) 459-1025
Fax: (208) 459-1080
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-10-05
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20201005002920 | I | Family Practice | ID | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 83036 | Hemoglobin a1c level | 24 | 14 | $0 |
Insurance plans in this area (ZIP 83653)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | CA | |
| - | ID | |
| Family Practice | ID | |
| Nurse Practitioner | ID | |
| - | ID | |
| - | ID | |
| Family Practice, Emergency Medicine | OR | |
| - | ID | |
| Family Practice | ID | |
| Family Practice | ID |
Reviews
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