St Lukes Clinic - Magic Valley/Jerome – Family Medicine Physician, NPI 1790718229
Family Medicine Physician
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for St Lukes Clinic - Magic Valley/Jerome
PO BOX 640
BOISE, ID 837010640
Phone: (208) 706-5000
Type: Mailing
132 5th Ave W Ste 1/2
Jerome, ID 833381825
Phone: (208) 814-9800
Type: Location
775, Pole Line Road West, Twin Falls, Twin Falls County, Idaho, 83301, United States
TWIN FALLS, ID 833015814
Phone: (208) 814-1000
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: 2023-01-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (984 days ago).
Enrollment records
19
Earliest due date
2023-09-30
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 |
|---|---|---|---|---|
| O20031208000899 | O | Clinic/Group Practice | ID | 2023-09-30 |
| O20090825000091 | O | Clinic/Group Practice | NV | TBD |
| O20140611002216 | O | Rural Health Clinic | ID | 2024-07-31 |
| O20210720002830 | O | Clinic/Group Practice | CO | 2026-07-31 |
| O20210812000233 | O | Clinic/Group Practice | DC | 2026-08-31 |
| O20210817000394 | O | Clinic/Group Practice | GA | 2026-09-30 |
| O20210817001980 | O | Clinic/Group Practice | AZ | TBD |
| O20210819001777 | O | Clinic/Group Practice | KS | TBD |
| O20210820002231 | O | Clinic/Group Practice | HI | TBD |
| O20210823002996 | O | Clinic/Group Practice | OH | TBD |
| O20210825002724 | O | Clinic/Group Practice | OR | TBD |
| O20210908001455 | O | Clinic/Group Practice | VA | TBD |
| O20210917002758 | O | Clinic/Group Practice | WA | TBD |
| O20210921002968 | O | Clinic/Group Practice | MA | TBD |
| O20211006003232 | O | Clinic/Group Practice | FL | TBD |
| O20211208001162 | O | Clinic/Group Practice | WI | TBD |
| O20220713002850 | O | Clinic/Group Practice | TX | TBD |
| O20221110000053 | O | Clinic/Group Practice | MD | TBD |
| O20230110000595 | O | Clinic/Group Practice | MI | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 83701)
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