NPIMap

Individual provider Active NPI

Oleg Sergeevich Kouskov, MD

  • Pulmonary Disease Physician
  • Meridian, ID
National Provider Identifier
1053521203
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
M11223 Issued in ID
Practice address
2347 E Gala St
Meridian, ID 83642-4881
Phone
(208) 323-3767
NPI assigned
May 23, 2007
Last updated
Jan 23, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X M11223 ID
Pulmonary Disease Physician 207RP1001X M11223 ID Primary

Addresses

Primary practice location

2347 E Gala St
Meridian, ID 83642-4881

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222

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
I20110816000647 ID Practitioner - Pulmonary Disease 8426227083 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

2347 E Gala St
Meridian, ID 83642-4881
Phone (208) 323-3767

305 E Jefferson St
Boise, ID 83712-6231
Phone (208) 345-0715

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M11223IDMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Mar 1, 2012 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

2051 E Summersweet Dr
Boise, ID 83716
Phone (208) 323-3767

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

2347 E Gala St
Meridian, ID 83642
Phone (208) 323-0031

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

Interoperability endpoints

  • Direct secure messaging: okouskov13886@direct.slhs.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1053521203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2347 E GALA ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424881",
            "telephone_number": "208-323-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUSKOV",
        "first_name": "OLEG",
        "middle_name": "SERGEEVICH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "ID",
            "license": "M11223",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ID",
            "license": "M11223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.