NPIMap

Individual provider Active NPI

Sydney Elizabeth Disselkamp, FNP

  • Nurse Practitioner
  • Coeur d'Alene, ID
National Provider Identifier
1023604089
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
63540 Issued in ID
Practice address
700 W Ironwood Dr Ste 378
Coeur D Alene, ID 83814-4401
Phone
(208) 625-3555
Fax
(208) 769-8616
NPI assigned
Dec 14, 2020
Last updated
Apr 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 63540 ID Primary

Addresses

Primary practice location

700 W Ironwood Dr Ste 378
Coeur D Alene, ID 83814-4401

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000

Other identifiers 1

IdentifierTypeStateIssuer
1023604089MedicaidID

Other names 1

  • Sydney Elizabeth Ciembor Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sdisselkamp818689@direct.multicare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220803001952 ID Practitioner - Nurse Practitioner 5890188338 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

600 N Cecil Rd
Post Falls, ID 83854-6200
Phone (208) 262-2800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. Current Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Kootenai Health, Inc. Nurse Practitioner Past Accepting new patients

Locations

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

700 W Ironwood Dr
Ste 378
Coeur D Alene, ID 83814
Phone (208) 625-3555

600 N Cecil Rd
Post Falls, ID 83854
Phone (208) 262-2800

Interoperability endpoints

  • Direct secure messaging: sdisselkamp@nwsh.gwaydirect.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1023604089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 378",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144401",
            "telephone_number": "208-625-3555",
            "fax_number": "208-769-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISSELKAMP",
        "first_name": "SYDNEY",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-14",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "63540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023604089",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdisselkamp818689@direct.multicare.org",
            "affiliation": "N",
            "address_1": "700 W Ironwood Dr Ste 378",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838144401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SYDNEY",
            "last_name": "CIEMBOR",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.