NPIMap

Organization Active NPI

Active Family Healthcare PLLC

  • Family Medicine Physician
  • Coeur d'Alene, ID
National Provider Identifier
1063764462
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ACTIVE FAMILY HEALTHCARE PLLC
Practice address
919 W Canfield Ave
Coeur D Alene, ID 83815-9764
Phone
(208) 758-0560
Fax
(208) 762-5424
NPI assigned
Oct 9, 2012
Last updated
Mar 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Dr. Jennifer Fletcher, NPNPI 1063454981
Title
Owner Nurse Practioner
Phone
(208) 758-0560

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

919 W Canfield Ave
Coeur D Alene, ID 83815-9764

Mailing address

919 W Canfield Ave
Coeur D Alene, ID 83815-9764
Phone (208) 758-0560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140709003055 ID Part B Supplier - Clinic/Group Practice 7315162237 Receives reassigned benefits from 8 practitioners
Practice locations: Coeur D Alene, ID
O20240911003430 HI Part B Supplier - Clinic/Group Practice 7315162237 Receives reassigned benefits from 1 practitioner
Practice locations: Kapaa, HI

National Provider Directory

National Provider Directory

Locations

8836 N Hess St
Ste E
Hayden, ID 83835
Phone (208) 758-0560

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1349740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1063764462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 W CANFIELD AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159764",
            "telephone_number": "208-758-0560",
            "fax_number": "208-762-5424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 W CANFIELD AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159764",
            "telephone_number": "208-758-0560",
            "fax_number": "208-762-5424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FAMILY HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-09",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER NURSE PRACTIONER",
        "authorized_official_telephone_number": "208-758-0560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.