KOOTENAI HEALTH (NPI# 1235288655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235288655 |
| Entity Type | Organization |
| Organization Name | KOOTENAI HEALTH |
| Other Organization Name | KOOTENAI MEDICAL CENTER GROUP |
| Practice Address |
2003 Kootenai Health Way Coeur D Alene ID 83814-6051 |
| Practice Telephone | 2086254000 |
| Mailing Telephone | 2086254000 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-10-02 |
| Authorized Official Name | JON D. NESS (CEO) |
| Authorized Official Telephone | 2086254000 |
| Is Organization Subpart | Y |
| Parent Organization Name | KOOTENAI HEALTH |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | 42 | ID | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | 42 | ID | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 42 | ID | Allopathic & Osteopathic Physicians |
| N | 213E00000X | Podiatrist | 42 | ID | Podiatric Medicine & Surgery Service Providers |
| N | 363A00000X | Physician Assistant | 42 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 42 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207P00000X | Emergency Medicine | 42 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 805712000 | 05 | |
| ID | BLUE CROSS | 83758 | 01 |
| ID | REGENCE BLUE SHIELD | 000010004926 | 01 |
| ID | RR MEDICARE | CG7380 | 01 |
| Other Name | Type Code |
|---|---|
| Kootenai Medical Center Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194345199 | Kootenai Health | Durable Medical Equipment & Medical Supplies | 700 W Ironwood Dr Ste 159, Coeur D Alene, ID 83814-4401 | 2020-04-20 |
| 1205113784 | Kootenai Health | Internal Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2011-11-10 |
| 1699807743 | Kootenai Health | Internal Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-03-12 |
| 1700918851 | Kootenai Health | Radiology | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-03-12 |
| 1174661151 | Kootenai Health | General Acute Care Hospital | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-02-02 |
| 1609925023 | Kootenai Health | Durable Medical Equipment & Medical Supplies | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-01-09 |
| 1316096738 | Kootenai Health | Counselor | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-01-09 |
| 1659476455 | Kootenai Health | Rehabilitation Unit | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2006-09-14 |
| 1568567360 | Kootenai Health | Psychiatric Unit | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2006-09-14 |
| 1992798409 | Kootenai Health | General Acute Care Hospital | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2005-08-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | KOOTENAI HEALTH | 2003 Kootenai Health Wy, Coeur D Alene, ID 83814-6051 |
| Street Address |
2003 KOOTENAI HEALTH WAY |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-6051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912909151 | Pamela S Pomeroy | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2005-06-01 |
| 1104425149 | Denise White | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2020-10-21 |
| 1992343487 | Audrey Nordness | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-12-15 |
| 1881245017 | Jackie Rae Fitting | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-29 |
| 1336790567 | Shane Oliver Withers Jr. | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-29 |
| 1447800552 | Keith Mccullough | Physician Assistant | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-19 |
| 1568012102 | Kaitlin Wendt | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-16 |
| 1215586862 | Heather A Hamilton | Social Worker | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-06 |
| 1205498193 | Guy Hoenke | Registered Nurse | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-07-01 |
| 1407417843 | Maddison M Ray | Dietitian, Registered | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972914406 | Jonathan Robert Jerkins | Emergency Medicine | 700 W Ironwood Dr Ste 155, Coeur D Alene, ID 83814-4462 | 2014-05-19 |
| 1023128493 | Thomas Patrick Martin | Emergency Medicine | 1221 W Ironwood Dr Ste 102, Coeur D Alene, ID 83814-1402 | 2006-08-30 |
| 1952363780 | Peter Richard Obligato | Emergency Medicine | 700 W Ironwood Dr Ste 170e, Coeur D Alene, ID 83814-2666 | 2006-04-05 |
| 1861485161 | Warren C Keene | Emergency Medicine | 2003 Lincoln Way, Coeur D Alene, ID 83814-2611 | 2005-08-23 |
| 1649734922 | Western Medical Associates, Pllc | Emergency Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-01-30 |
| 1871024406 | Jonathan Parley Wright | Emergency Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2017-03-24 |
| 1083078398 | Spencer James Cross | Emergency Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2016-04-12 |
| 1336521335 | Erin Wenzel | Emergency Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2015-06-25 |
| 1225472012 | Craig A Burns | Emergency Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2013-04-23 |
| 1669727665 | Travis Aaron Newby | Emergency Medicine | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2012-07-17 |
| Find all providers in COEUR D ALENE | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.