Active NPI
Thomas R Rau, MD
- Pediatrics Physician
- Coeur D Alene, ID
National Provider Identifier
1013927979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M5461
- Practice address
- 700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656 - Phone
- (208) 667-0585
- Fax
- (208) 667-0876
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M5461 | ID | Primary |
Addresses
Primary practice location
700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656
Mailing address
700 W Ironwood Dr
Suite 155
Coeur D Alene, ID 83814-2656
Phone (208) 667-0585
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010003964 | Other | ID | REGENCE BLUE SHIELD |
| 002584800 | Medicaid | ID | |
| 54619 | Other | ID | BLUE CROSS OF IDAHO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5461 | ID | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kootenai Health, Inc. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/6242/brand/1/csg/1/fhir/r4
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387324800000",
"number": "1013927979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 W IRONWOOD DR",
"address_2": "SUITE 155",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142656",
"telephone_number": "208-667-0585",
"fax_number": "208-667-0876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 W IRONWOOD DR",
"address_2": "SUITE 155",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142656",
"telephone_number": "208-667-0585",
"fax_number": "208-667-0876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAU",
"first_name": "THOMAS",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2013-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ID",
"license": "M5461",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010003964",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002584800",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "54619",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.